Provider Demographics
NPI:1346530557
Name:GIOLITTI, DINO JOSEPH (PMHNP)
Entity Type:Individual
Prefix:
First Name:DINO
Middle Name:JOSEPH
Last Name:GIOLITTI
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 GRELLE AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-5202
Mailing Address - Country:US
Mailing Address - Phone:916-532-7306
Mailing Address - Fax:
Practice Address - Street 1:523 1/2 MAIN ST # 7
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1870
Practice Address - Country:US
Practice Address - Phone:208-413-9973
Practice Address - Fax:208-413-9976
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1399A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20285OtherFNP LICENSE