Provider Demographics
NPI:1720556236
Name:TOLBERT, MARGARET SIA (RN)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:SIA
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:SIA
Other - Last Name:TOLBERT-WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9118 WOODHALL XING N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1621
Mailing Address - Country:US
Mailing Address - Phone:763-339-1869
Mailing Address - Fax:
Practice Address - Street 1:9118 WOODHALL XING N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1621
Practice Address - Country:US
Practice Address - Phone:763-339-1869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN167979-9163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health