Provider Demographics
NPI:1851757504
Name:NOLLEY, TONAE (BA)
Entity Type:Individual
Prefix:
First Name:TONAE
Middle Name:
Last Name:NOLLEY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24512 TUSCARORA CIR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5818
Mailing Address - Country:US
Mailing Address - Phone:951-455-9394
Mailing Address - Fax:
Practice Address - Street 1:24512 TUSCARORA CIR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5818
Practice Address - Country:US
Practice Address - Phone:951-455-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator