Provider Demographics
NPI:1407671936
Name:PEARSON, TRISTAN (LE)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 BURLINGTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5666
Mailing Address - Country:US
Mailing Address - Phone:406-241-0674
Mailing Address - Fax:
Practice Address - Street 1:1018 BURLINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5666
Practice Address - Country:US
Practice Address - Phone:406-241-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician