Individual provider Active NPI

Tricia Leigh Tollenaar, CRNA

  • Certified Registered Nurse Anesthetist
  • Marquette, MI
National Provider Identifier
1164746475
Registry record updated Mar 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704235224 Issued in MI
Practice address
420 W Magnetic St
Anesthesia Dept.
Marquette, MI 49855-2711
Phone
(906) 225-3595
NPI assigned
Mar 16, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 4704235224 MI Primary

Addresses

Primary practice location

420 W Magnetic St
Anesthesia Dept.
Marquette, MI 49855-2711

Mailing address

351 W Main St
Unit # 9
Marquette, MI 49855-9348
Phone (239) 580-7379

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190225001049 OR Practitioner - Certified Registered Nurse Anesthetist (Crna) 3476683236 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
4704235224MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Associates Northwest LLC CurrentSince Jan 15, 2019 Accepting new patients
Marquette General Hospital, Inc. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

10150 SE 32nd Ave
Portland, OR 97222
Phone (503) 215-4202

120 NW 14th Ave
Ste 200
Portland, OR 97209
Phone (503) 771-1883

6400 SE Lake Rd
Ste 130
Portland, OR 97222
Phone (503) 594-1774

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268697600000",
    "number": "1164746475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 W MAIN ST",
            "address_2": "UNIT # 9",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498559348",
            "telephone_number": "239-580-7379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W MAGNETIC ST",
            "address_2": "ANESTHESIA DEPT.",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552711",
            "telephone_number": "906-225-3595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLLENAAR",
        "first_name": "TRICIA",
        "middle_name": "LEIGH",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-16",
        "last_updated": "2010-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704235224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marquette, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.