Provider Demographics
NPI:1497964019
Name:COLVIN, DUSTIN L (STNA)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:L
Last Name:COLVIN
Suffix:
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-3439
Mailing Address - Country:US
Mailing Address - Phone:419-424-2156
Mailing Address - Fax:
Practice Address - Street 1:610 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3439
Practice Address - Country:US
Practice Address - Phone:419-424-2156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400617790507374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide