Healthcare Provider Details

I. General information

NPI: 1821916792
Provider Name (Legal Business Name): TRISTEN PAUL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 E REID RD APT 4
GRAND BLANC MI
48439-1296
US

IV. Provider business mailing address

627 E REID RD APT 4
GRAND BLANC MI
48439-1296
US

V. Phone/Fax

Practice location:
  • Phone: 810-322-6188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704418841
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: