=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760473946
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNINE M TONETTI NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 NORTH ST SUITE 301
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-499-8570
-----------------------------------------------------
Fax | 413-499-8565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1690
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01202-1690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-499-8568
-----------------------------------------------------
Fax | 413-499-8580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LX0001X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
-----------------------------------------------------
License Number | 171676
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------