Healthcare Provider Details

I. General information

NPI: 1699172148
Provider Name (Legal Business Name): CARLA TOLER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2014
Last Update Date: 11/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8623 QUINCY ST
DETROIT MI
48204-2338
US

IV. Provider business mailing address

8623 QUINCY ST
DETROIT MI
48204-2338
US

V. Phone/Fax

Practice location:
  • Phone: 313-671-0561
  • Fax:
Mailing address:
  • Phone: 313-671-0561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number163WH0200X
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: