Healthcare Provider Details

I. General information

NPI: 1487164372
Provider Name (Legal Business Name): ANDREA KAYE TOLMAN RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 E FOREMASTER DR STE 140
ST GEORGE UT
84790-5832
US

IV. Provider business mailing address

1424 E FOREMASTER DR STE 140
ST GEORGE UT
84790-5832
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-2888
  • Fax: 435-251-2878
Mailing address:
  • Phone: 435-251-2888
  • Fax: 435-251-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number7666215-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: