Provider Demographics
NPI:1710450416
Name:BETOURNAY-GAMELLI, JEANNE MARIE (DNP, AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:MARIE
Last Name:BETOURNAY-GAMELLI
Suffix:
Gender:F
Credentials:DNP, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3419
Mailing Address - Country:US
Mailing Address - Phone:413-531-9160
Mailing Address - Fax:
Practice Address - Street 1:60 IRVING ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3419
Practice Address - Country:US
Practice Address - Phone:413-531-9160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7847363L00000X
MARN150403363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner