Provider Demographics
NPI:1407294077
Name:TOLLE, MERCEDES ELISA
Entity Type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:ELISA
Last Name:TOLLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 SKYVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2923
Mailing Address - Country:US
Mailing Address - Phone:307-287-1275
Mailing Address - Fax:
Practice Address - Street 1:1516 SKYVIEW CIR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2923
Practice Address - Country:US
Practice Address - Phone:307-287-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator