Provider Demographics
NPI:1598066359
Name:TOLBERT, ANGIE MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:MARIE
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10340 KASILOF BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-6427
Mailing Address - Country:US
Mailing Address - Phone:907-360-1665
Mailing Address - Fax:
Practice Address - Street 1:4050 LAKE OTIS PKWY
Practice Address - Street 2:110
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5223
Practice Address - Country:US
Practice Address - Phone:907-770-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK26003163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation