Healthcare Provider Details

I. General information

NPI: 1669933479
Provider Name (Legal Business Name): TRISTIN ELIZABETH NEUMANN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISTIN BRUENING

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 N MISSOURI ST
MACON MO
63552-2149
US

IV. Provider business mailing address

PO BOX 1239
HANNIBAL MO
63401-1239
US

V. Phone/Fax

Practice location:
  • Phone: 660-395-7575
  • Fax: 660-665-7576
Mailing address:
  • Phone: 573-629-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019035102
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041385599
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018801
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019035708
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: