Provider Demographics
NPI:1922423227
Name:TOLSON, MONTINIQUE
Entity Type:Individual
Prefix:
First Name:MONTINIQUE
Middle Name:
Last Name:TOLSON
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 1:23234 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3678
Mailing Address - Country:US
Mailing Address - Phone:734-430-5564
Mailing Address - Fax:
Practice Address - Street 1:23234 POPLAR DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3678
Practice Address - Country:US
Practice Address - Phone:734-430-5564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-23
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703102049372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion