Provider Demographics
NPI:1518952217
Name:COLE, DOROTHY (CRNA)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CHIPPEWA DR
Mailing Address - Street 2:104B
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1378
Mailing Address - Country:US
Mailing Address - Phone:270-843-0593
Mailing Address - Fax:
Practice Address - Street 1:1725 ASHLEY CIR
Practice Address - Street 2:#209A
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3337
Practice Address - Country:US
Practice Address - Phone:270-782-9994
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-0131870207L00000X
KY1107899367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74010935Medicaid
KY000000378816OtherANTHEM
ALR38407Medicare UPIN
KY000000378816OtherANTHEM