MEDICARE: MS. HARRIET A TOOTLE CRNP

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	R046765	MD

General Provider Information

NPI Number	:	1417013418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HARRIET A TOOTLE CRNP

Provider Business Mailing Address
First Line	:	2101 EAST JEFFERSON STREET
Second Line	:	KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-6660
Fax Number	:	301-816-6308

Provider Business Practice Location Address
First Line	:	7141 SECURITY BOULEVARD
Second Line	:	KAISER PERMANENTE PPQA 6 WEST ATTN THERESA BROOKS
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-1811
Country	:	US
Telephone Number	:	443-663-6170
Fax Number	:	443-663-6308

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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