Provider Demographics
NPI:1538311352
Name:BUCHHOLZ, TONYA D (CNP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:D
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:D
Other - Last Name:FROEHLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:323 SW 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-3200
Mailing Address - Country:US
Mailing Address - Phone:605-256-6551
Mailing Address - Fax:605-256-6469
Practice Address - Street 1:323 SW 10TH STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-3200
Practice Address - Country:US
Practice Address - Phone:605-256-6551
Practice Address - Fax:605-256-6469
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000546363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6831610Medicaid
SDP00664632OtherRAILROAD MEDICARE
SD6831610Medicaid