Provider Demographics
NPI:1790420834
Name:TOLLESON, DANA BREANN
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:BREANN
Last Name:TOLLESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 ADDISON CIR STE 400
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6049
Mailing Address - Country:US
Mailing Address - Phone:214-983-0303
Mailing Address - Fax:214-983-0301
Practice Address - Street 1:5040 ADDISON CIR STE 400
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6049
Practice Address - Country:US
Practice Address - Phone:214-983-0303
Practice Address - Fax:214-983-0301
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical