Provider Demographics
NPI:1609003003
Name:TOLSTYKA, KIMBERLY ANN (RN/CCM)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:TOLSTYKA
Suffix:
Gender:F
Credentials:RN/CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23475 STACEY DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5473
Mailing Address - Country:US
Mailing Address - Phone:734-789-9902
Mailing Address - Fax:734-789-9903
Practice Address - Street 1:23475 STACEY DR
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48183-5473
Practice Address - Country:US
Practice Address - Phone:734-789-9902
Practice Address - Fax:734-789-9903
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201685163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704194576OtherRN
00064415OtherCCM
OH201685OtherRN