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General NPI Number Information
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NPI Number | 1700044500
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Entity Type | Individual
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Provider Name | TINA LOUISE TOLES IDC
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Gender | Female
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | MARINE CORPS SECURITY FORCES BATTALION
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City | FPO
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State | AP
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Zip | 98315
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Country | US
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Telephone | 360-204-0388
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Fax |
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Provider Business Mailing Address
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Address Line | 11189 SEABECK HWY NW
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City | SEABECK
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State | WA
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Zip | 98380-9558
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Country | US
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Telephone | 619-387-6376
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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 | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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