Basic Information
| Provider Information | |||||||||
| NPI: | 1154082725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOLLISON | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2147 WOODHAVEN CT | ||||||||
| Address2: | |||||||||
| City: | VILLA HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8598667247 | ||||||||
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| Practice Location | |||||||||
| Address1: | 820 DOLWICK DR | ||||||||
| Address2: | |||||||||
| City: | ERLANGER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410182774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594295188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2022 | ||||||||
| LastUpdateDate: | 01/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 1147242 | KY | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.