Healthcare Provider Details

I. General information

NPI: 1255813242
Provider Name (Legal Business Name): RAYANN TOLSTEDT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 SWEETWATER AVE
ALLIANCE NE
69301-2668
US

IV. Provider business mailing address

1604 SWEETWATER AVE
ALLIANCE NE
69301-2668
US

V. Phone/Fax

Practice location:
  • Phone: 308-760-7343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number65599
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: