Provider Demographics
NPI:1821416371
Name:BRISTOL, JANIE RUTH (RN)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:RUTH
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JANIE
Other - Middle Name:RUTH
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1503 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5967
Mailing Address - Country:US
Mailing Address - Phone:931-484-6196
Mailing Address - Fax:931-456-1047
Practice Address - Street 1:1503 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5967
Practice Address - Country:US
Practice Address - Phone:931-484-6196
Practice Address - Fax:931-456-1047
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000077864164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse