Provider Demographics
NPI:1366968562
Name:TOLLE, NICHOLE E (CST)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:E
Last Name:TOLLE
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8333 NAAB RD STE 250
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1983
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:317-396-1346
Practice Address - Street 1:3750 LANDMARK DR STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-6652
Practice Address - Country:US
Practice Address - Phone:765-448-7981
Practice Address - Fax:765-447-4172
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant