Provider Demographics
NPI:1881576437
Name:TOLO, KEZZY LORRINE ATIENO (RN)
Entity type:Individual
Prefix:
First Name:KEZZY
Middle Name:LORRINE ATIENO
Last Name:TOLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 GROVESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8396
Mailing Address - Country:US
Mailing Address - Phone:910-318-5422
Mailing Address - Fax:
Practice Address - Street 1:3130 GROVESHIRE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-8396
Practice Address - Country:US
Practice Address - Phone:910-318-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC278974163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse