Provider Demographics
NPI:1538829080
Name:TOLAND, JENNIE NGUYEN (APRN, IBCLC)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:NGUYEN
Last Name:TOLAND
Suffix:
Gender:F
Credentials:APRN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W ROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2131
Mailing Address - Country:US
Mailing Address - Phone:620-225-1650
Mailing Address - Fax:620-227-2505
Practice Address - Street 1:120 W ROSS BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2131
Practice Address - Country:US
Practice Address - Phone:620-225-1605
Practice Address - Fax:620-227-2505
Is Sole Proprietor?:No
Enumeration Date:2021-12-25
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS135874163WL0100X, 163W00000X
KS53-82832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse