Provider Demographics
NPI:1104921501
Name:COLONT, VIVIAN L (RN APRN NURSE PRACTI)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:L
Last Name:COLONT
Suffix:
Gender:F
Credentials:RN APRN NURSE PRACTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 GREENBELT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-982-0032
Mailing Address - Fax:865-983-4172
Practice Address - Street 1:414 GREENBELT DRIVE
Practice Address - Street 2:MARYVILLE PEDIATRIC GROUP
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-982-0032
Practice Address - Fax:865-983-4172
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN89370363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics