Basic Information
| Provider Information | |||||||||
| NPI: | 1821002031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CISTOLA | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 FRANKLIN PIKE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372042227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159838247 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2637 MURFREESBORO PIKE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372173505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152929770 | ||||||||
| FaxNumber: | 6159646951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 07/03/2013 | ||||||||
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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 | 207V00000X | MD0000024871 | TN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 3097556 | 05 | TN | MEDICAID | 4119515 | 05 | TN | MEDICAID |