Provider Demographics
NPI:1578396172
Name:TOLBER, KENNEDY
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:TOLBER
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 1:6334 HANSLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:43155-9759
Mailing Address - Country:US
Mailing Address - Phone:614-330-3503
Mailing Address - Fax:
Practice Address - Street 1:6334 HANSLEY RD
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:OH
Practice Address - Zip Code:43155-9759
Practice Address - Country:US
Practice Address - Phone:614-330-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide