MEDICARE: VIOLET MGENI BARUTI PHMNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	401676	NY

General Provider Information

NPI Number	:	1508289919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIOLET MGENI BARUTI PHMNP

Provider Business Mailing Address
First Line	:	17599 COUNTY ROUTE 66
Second Line	:
City	:	SACKETS HARBOR
State	:	NY
Zip	:	13685-3141
Country	:	US
Telephone Number	:	713-382-5890
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 BRIDGE ST
Second Line	:
City	:	CARTHAGE
State	:	NY
Zip	:	13619-1360
Country	:	US
Telephone Number	:	713-382-5890
Fax Number	:

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

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	03/01/2014

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