Provider Demographics
NPI:1255112439
Name:BIRDZELL, TRISTA LEEANN (DEM)
Entity type:Individual
Prefix:MRS
First Name:TRISTA
Middle Name:LEEANN
Last Name:BIRDZELL
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 S 1000 E
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2119
Mailing Address - Country:US
Mailing Address - Phone:623-258-9587
Mailing Address - Fax:
Practice Address - Street 1:29 S 1000 E
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2119
Practice Address - Country:US
Practice Address - Phone:623-258-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay