Provider Demographics
NPI:1053744003
Name:TOLLEY, SHERNETTE J
Entity type:Individual
Prefix:MRS
First Name:SHERNETTE
Middle Name:J
Last Name:TOLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHERNETTE
Other - Middle Name:J
Other - Last Name:MCLEOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:4 SUTHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-4309
Mailing Address - Country:US
Mailing Address - Phone:843-722-8624
Mailing Address - Fax:
Practice Address - Street 1:244 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-4742
Practice Address - Country:US
Practice Address - Phone:843-724-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62153163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse