Provider Demographics
NPI:1043269418
Name:JANNETTI, NINA (DO)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:JANNETTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 BEECHNUT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3100
Mailing Address - Country:US
Mailing Address - Phone:713-777-7145
Mailing Address - Fax:713-337-4803
Practice Address - Street 1:7710 BEECHNUT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-3100
Practice Address - Country:US
Practice Address - Phone:713-777-7145
Practice Address - Fax:713-337-4803
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03055TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132683704Medicaid
TX86X117Medicare PIN
TX132683704Medicaid