Provider Demographics
NPI:1275558272
Name:TOLLE, BEVERLY G (NP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:G
Last Name:TOLLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 STATE ROUTE 159 STE 150
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-7833
Mailing Address - Country:US
Mailing Address - Phone:740-779-8840
Mailing Address - Fax:
Practice Address - Street 1:4439 STATE ROUTE 159 STE 150
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7833
Practice Address - Country:US
Practice Address - Phone:740-779-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.07052.NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2368138Medicaid
OHNP11823Medicare PIN
OHP74950Medicare UPIN