Provider Demographics
NPI:1033284039
Name:TOLK, NANCY JEANNE (BOC CERTIFIED)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JEANNE
Last Name:TOLK
Suffix:
Gender:F
Credentials:BOC CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:1013 VALLEY VIEW ROAD
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-2229
Mailing Address - Country:US
Mailing Address - Phone:707-725-6116
Mailing Address - Fax:707-725-6116
Practice Address - Street 1:1013 VALLEY VIEW ROAD
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2229
Practice Address - Country:US
Practice Address - Phone:707-725-6116
Practice Address - Fax:707-725-6116
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
C17591OtherBOARD OF CERTIFICATION NU
2275OtherREGISTERED
2275OtherREGISTERED