MEDICARE: JEANETTE NORMA TUITT NP

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	364SW0102X	Women's Health Clinical Nurse Specialist	126175	MA

General Provider Information

NPI Number	:	1659544633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE NORMA TUITT NP

Provider Business Mailing Address
First Line	:	25 LHEUREUX CIR
Second Line	:
City	:	RANDOLPH
State	:	MA
Zip	:	02368-5176
Country	:	US
Telephone Number	:	781-963-0984
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 BLUE HILL AVE
Second Line	:	MATTAPAN COMMUNITY HEALTH CENTER
City	:	BOSTON
State	:	MA
Zip	:	02126
Country	:	US
Telephone Number	:	617-296-0061
Fax Number	:	617-296-5408

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

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	04/10/2008

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