Provider Demographics
NPI:1790167286
Name:GOLSON, TOMEKIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TOMEKIA
Middle Name:
Last Name:GOLSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 ENDURING FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5595
Mailing Address - Country:US
Mailing Address - Phone:919-675-9596
Mailing Address - Fax:
Practice Address - Street 1:3501 ENDURING FREEDOM DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-5595
Practice Address - Country:US
Practice Address - Phone:919-675-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65006164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC65006OtherNCBON