Healthcare Provider Details

I. General information

NPI: 1376623645
Provider Name (Legal Business Name): MARYANNE O'TOOLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 HARRY KEMP WAY
PROVINCETOWN MA
02657
US

IV. Provider business mailing address

PO BOX 1413
WELLFLEET MA
02667
US

V. Phone/Fax

Practice location:
  • Phone: 508-487-9395
  • Fax: 508-487-3285
Mailing address:
  • Phone: 508-240-0208
  • Fax: 508-240-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number190922
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: