Provider Demographics
NPI:1023315132
Name:TOLBERT, ELIZABETH R (LPN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:TOLBERT
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 1:27 PROVIDENCE DR
Mailing Address - Street 2:#138
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-8517
Mailing Address - Country:US
Mailing Address - Phone:513-673-2883
Mailing Address - Fax:
Practice Address - Street 1:27 PROVIDENCE DR
Practice Address - Street 2:#138
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-8517
Practice Address - Country:US
Practice Address - Phone:513-673-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN130468164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse