Healthcare Provider Details

I. General information

NPI: 1609353705
Provider Name (Legal Business Name): LAURA TOLSON AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SAVANNAH RD
LEWES DE
19958-1462
US

IV. Provider business mailing address

30503 OAK RIDGE DR
MILLSBORO DE
19966-2700
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3300
  • Fax:
Mailing address:
  • Phone: 302-841-3231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0033535
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberLP-0000274
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: