1497261234 NPI number — MS. ZELMA RAE TOLER PCA

Table of content: MS. ZELMA RAE TOLER PCA (NPI 1497261234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497261234 NPI number — MS. ZELMA RAE TOLER PCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOLER
Provider First Name:
ZELMA
Provider Middle Name:
RAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PCA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROOKS
Provider Other First Name:
ZELMA
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497261234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 623
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-356-4562
Provider Business Mailing Address Fax Number:
304-558-4563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 RIVERSIDE DRIVE
Provider Second Line Business Practice Location Address:
DUNROVAN ESTATE
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-523-5484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0034210000 . This is a "PROVIDER ID" identifier . This identifiers is of the category "OTHER".




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