Healthcare Provider Details

I. General information

NPI: 1922928696
Provider Name (Legal Business Name): TATIANA AILEENE TOLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 E CHASEWOOD DR
AMMON ID
83406-4007
US

IV. Provider business mailing address

246 N CURLEW DR APT 5207
AMMON ID
83401-1441
US

V. Phone/Fax

Practice location:
  • Phone: 208-932-1154
  • Fax:
Mailing address:
  • Phone: 541-570-5231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number73820
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: