Basic Information
| Provider Information | |||||||||
| NPI: | 1104921501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLONT | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | RN APRN NURSE PRACTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 414 GREENBELT DRIVE | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659820032 | ||||||||
| FaxNumber: | 8659834172 | ||||||||
| Practice Location | |||||||||
| Address1: | 414 GREENBELT DRIVE | ||||||||
| Address2: | MARYVILLE PEDIATRIC GROUP | ||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659820032 | ||||||||
| FaxNumber: | 8659834172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN89370 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.