Provider Demographics
NPI:1386912392
Name:ROLSTON, JON ERIC (CRNA)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:ERIC
Last Name:ROLSTON
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:BOX 217
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-744-3664
Mailing Address - Fax:918-748-7688
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:BOX 217
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-744-3664
Practice Address - Fax:918-748-7688
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2014-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK84412367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered