Provider Demographics
NPI:1073310892
Name:TOOTHMAN, DELAINA MARIE
Entity type:Individual
Prefix:
First Name:DELAINA
Middle Name:MARIE
Last Name:TOOTHMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16730 ALLORA CT UNIT 118
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-5580
Mailing Address - Country:US
Mailing Address - Phone:512-787-0878
Mailing Address - Fax:
Practice Address - Street 1:16730 ALLORA CT UNIT 118
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-5580
Practice Address - Country:US
Practice Address - Phone:512-787-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care