Provider Demographics
NPI:1104219153
Name:HUSTON, TOSHIA M (RN)
Entity Type:Individual
Prefix:
First Name:TOSHIA
Middle Name:M
Last Name:HUSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TOSHIA
Other - Middle Name:
Other - Last Name:MARCUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1919 UNIVERSITY AVE, STE 130
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-647-0017
Mailing Address - Fax:651-647-3423
Practice Address - Street 1:1919 UNIVERSITY AVE, STE 130
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-647-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR219232-7163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
248030Medicare Oscar/Certification