Healthcare Provider Details

I. General information

NPI: 1114173689
Provider Name (Legal Business Name): RHONDA KOLYER TOCCO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 ELLIOTT DR
YPSILANTI MI
48197-8633
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR LBBY J2000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8000
  • Fax: 734-712-8010
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704162219
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704162219
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: