Provider Demographics
NPI:1760621338
Name:TOLSMA LLC
Entity Type:Organization
Organization Name:TOLSMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOLSMA
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:715-623-3761
Mailing Address - Street 1:1111 LANGLADE RD
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2738
Mailing Address - Country:US
Mailing Address - Phone:715-623-3761
Mailing Address - Fax:715-623-3764
Practice Address - Street 1:1111 LANGLADE RD
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2738
Practice Address - Country:US
Practice Address - Phone:715-623-3761
Practice Address - Fax:715-623-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1399033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43895600Medicaid
WI43895600Medicaid
WI000083984Medicare PIN