Individual
MRS. MARY TOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
12502 WILLOWBROOK RD, SUITE 300, CUMBERLAND, MD 21502-6491
(240) 964-8787
(240) 964-8687
Mailing address
12404 BUTLER DR NW, LAVALE, MD 21502-6026
(301) 759-3968
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R062454
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
621091100
—
MD
Enumeration date
01/18/2007
Last updated
11/18/2014
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