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General NPI Number Information
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NPI Number | 1750901906
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Entity Type | Individual
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Provider Name | MCKENZIE MARIE TOLAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/17/2020
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 3270 VILLA LN
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City | NAPA
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State | CA
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Zip | 94558-3085
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Country | US
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Telephone | 72-513-6087
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Fax |
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Provider Business Mailing Address
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Address Line | 420 DELAWARE ST SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55455-0341
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Country | US
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Telephone | 612-625-7692
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 201596
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License Number State | CA
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