Healthcare Provider Details

I. General information

NPI: 1982111001
Provider Name (Legal Business Name): SHIRLEY MARIE TOLBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 JONATHAN PLACE
PITTSBURGH PA
15221-2419
US

IV. Provider business mailing address

528 ARDMORE BLVD
PITTSBURGH PA
15221-3021
US

V. Phone/Fax

Practice location:
  • Phone: 412-612-0114
  • Fax:
Mailing address:
  • Phone: 412-403-7374
  • Fax: 412-871-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN540064
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN540064
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: