Provider Demographics
NPI:1346873254
Name:COLSTON, SANDRA LYNN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:COLSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15081 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:CRITTENDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41030-8205
Mailing Address - Country:US
Mailing Address - Phone:513-431-8325
Mailing Address - Fax:
Practice Address - Street 1:15081 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:CRITTENDEN
Practice Address - State:KY
Practice Address - Zip Code:41030-8205
Practice Address - Country:US
Practice Address - Phone:513-431-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion