Basic Information
| Provider Information | |||||||||
| NPI: | 1992238513 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOLMAN | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | WESLEY | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 507 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640681025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163082619 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 NW R D MIZE RD STE 206 | ||||||||
| Address2: | |||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640142513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166555403 | ||||||||
| FaxNumber: | 8166555257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2017 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 14-112752-022 | KS | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 2021050737 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 20077029440 | MO | Y | Nursing Service Providers | Registered Nurse |
No ID Information.