MEDICARE: JANETTE DALTON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	5063	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4108255	OTHER	TN	BCBS OF TN

General Provider Information

NPI Number	:	1225075401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANETTE DALTON FNP

Provider Business Mailing Address
First Line	:	916 HARRISON FERRY RD
Second Line	:
City	:	WHITE PINE
State	:	TN
Zip	:	37890-4903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 2ND ST
Second Line	:
City	:	NEWPORT
State	:	TN
Zip	:	37821-3703
Country	:	US
Telephone Number	:	423-625-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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