Provider Demographics
NPI:1407437684
Name:NOLTON, TAMEKA ROSHELL (REGISTERED NURSE,)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:ROSHELL
Last Name:NOLTON
Suffix:
Gender:F
Credentials:REGISTERED NURSE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 POND RUN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2198
Mailing Address - Country:US
Mailing Address - Phone:586-298-4738
Mailing Address - Fax:
Practice Address - Street 1:4642 POND RUN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2198
Practice Address - Country:US
Practice Address - Phone:586-298-4738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704312628163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse