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General NPI Number Information
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NPI Number | 1578023438
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Entity Type | Individual
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Provider Name | KACI LEE TOLZMAN NP
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Gender | Female
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 107 OAK ST W STE 100
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City | FREDERIC
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State | WI
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Zip | 54837-9049
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Country | US
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Telephone | 715-318-0916
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 280TH ST
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City | CLEAR LAKE
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State | WI
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Zip | 54005-4417
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Country | US
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Telephone | 715-205-2786
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16639-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 16639-33
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License Number State | WI
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