Provider Demographics
NPI:1558395970
Name:HALLETT, NANETTE L (NP)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:L
Last Name:HALLETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3040
Mailing Address - Country:US
Mailing Address - Phone:508-778-8818
Mailing Address - Fax:
Practice Address - Street 1:140 YARMOUTH RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3040
Practice Address - Country:US
Practice Address - Phone:508-778-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA170215363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0372421Medicaid
MANP3484Medicare ID - Type Unspecified
P37109Medicare UPIN