Provider Demographics
NPI:1093499824
Name:TOOTELL-QUEVEDO, CHRISTIEN EMILIANO (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTIEN
Middle Name:EMILIANO
Last Name:TOOTELL-QUEVEDO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:CHRISTIEN
Other - Middle Name:EMILIANO
Other - Last Name:QUEVEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1822 N MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1350
Mailing Address - Country:US
Mailing Address - Phone:508-687-2597
Mailing Address - Fax:
Practice Address - Street 1:1822 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1350
Practice Address - Country:US
Practice Address - Phone:508-687-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2336777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health