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NPI Code Detail

MEDICARE: HEATHER R TONELLO P.A.-C

MEDICARE:   HEATHER R TONELLO  P.A.-C
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
1363AM0700XMedical Physician Assistant5601004123MI

General Provider Information

NPI Number : 1871579466
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER R TONELLO P.A.-C
Provider Business Mailing Address
First Line : 9249 W LAKE CITY RD
Second Line :
City : HOUGHTON LAKE
State : MI
Zip : 48629-9602
Country : US
Telephone Number : 989-422-5122
Fax Number : 989-422-4378
Provider Business Practice Location Address
First Line : 9249 W LAKE CITY RD
Second Line :
City : HOUGHTON LAKE
State : MI
Zip : 48629-9602
Country : US
Telephone Number : 989-422-5122
Fax Number : 989-422-4378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2005
Last Update Date : 12/11/2014

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Directions to “ HEATHER R TONELLO P.A.-C” Practice Location

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