Healthcare Provider Details

I. General information

NPI: 1346056892
Provider Name (Legal Business Name): KAITLYNN DENISE TOLONEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ALLEN DR
HIGHLAND MI
48357-3504
US

IV. Provider business mailing address

2300 HAGGERTY RD STE 1010
WEST BLOOMFIELD MI
48323-2185
US

V. Phone/Fax

Practice location:
  • Phone: 248-330-6682
  • Fax:
Mailing address:
  • Phone: 248-926-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704373349
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: