Provider Demographics
NPI:1083017636
Name:TOLY-HUGHES, BETH OLDIS (CNM)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:OLDIS
Last Name:TOLY-HUGHES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:OLDIS
Other - Last Name:TOLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6668 FOURTH SECTION RD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2448
Mailing Address - Country:US
Mailing Address - Phone:585-637-2670
Mailing Address - Fax:585-637-3678
Practice Address - Street 1:6668 FOURTH SECTION RD
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2448
Practice Address - Country:US
Practice Address - Phone:585-637-2670
Practice Address - Fax:585-637-3678
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001643367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01518708OtherMEDICARE RR
NY03990549Medicaid
NYJ400179507/GRPBA0017Medicare PIN
NYJ400179502/GRP70008AMedicare PIN