Provider Demographics
NPI:1669970505
Name:TOLBERT, CHRISTIAN LANIECE (STNA)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:LANIECE
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:LANIECE
Other - Last Name:TOLBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STNA
Mailing Address - Street 1:2902 CEDAR AVE APT 37
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2983
Mailing Address - Country:US
Mailing Address - Phone:216-246-9103
Mailing Address - Fax:
Practice Address - Street 1:2902 CEDAR AVE APT 37
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2983
Practice Address - Country:US
Practice Address - Phone:216-246-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401865920616376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401865920616OtherSTNA LICENSE