Healthcare Provider Details

I. General information

NPI: 1053149963
Provider Name (Legal Business Name): LYNDA JEAN TENORIO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 NORTH ST
PITTSFIELD MA
01201-4147
US

IV. Provider business mailing address

777 NORTH ST
PITTSFIELD MA
01201-4147
US

V. Phone/Fax

Practice location:
  • Phone: 413-499-8590
  • Fax: 413-499-6410
Mailing address:
  • Phone: 413-499-8590
  • Fax: 413-499-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2296398
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: