Provider Demographics
NPI:1982673828
Name:COLSTON, DORIS M (CRNA)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:M
Last Name:COLSTON
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:PO BOX 5059
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37831-5059
Mailing Address - Country:US
Mailing Address - Phone:800-611-6713
Mailing Address - Fax:770-237-1124
Practice Address - Street 1:990 OAK RIDGE TPKE
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6976
Practice Address - Country:US
Practice Address - Phone:865-481-1112
Practice Address - Fax:770-237-1124
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52018367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74158650Medicaid
TN52018OtherNURSING LICENSE NUMBER
TN3605701Medicaid
TN3605701Medicare PIN