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General NPI Number Information
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NPI Number | 1881045375
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Entity Type | Individual
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Provider Name | TRISTINE BOGLE R.D.
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Gender | Female
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Dates
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Enumeration Date | 06/26/2016
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 4838 E BASELINE RD STE 122
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City | MESA
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State | AZ
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Zip | 85206-4675
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Country | US
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Telephone | 602-694-4011
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Fax | 833-561-1964
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Provider Business Mailing Address
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Address Line | 3564 E MESQUITE ST
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City | GILBERT
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State | AZ
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Zip | 85296-1830
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Country | US
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Telephone | 602-622-0142
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Fax | 833-561-1964
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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