Provider Demographics
NPI:1922244219
Name:TINNEY, JEANETTE J M (PHN)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:J M
Last Name:TINNEY
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:JOYCE
Other - Last Name:MIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:31 FIRST AVE
Mailing Address - Street 2:PO BOX 412
Mailing Address - City:MAYFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:12117-0412
Mailing Address - Country:US
Mailing Address - Phone:518-661-5572
Mailing Address - Fax:
Practice Address - Street 1:2714 STATE HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-4041
Practice Address - Country:US
Practice Address - Phone:518-736-5720
Practice Address - Fax:518-762-1382
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-217611163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse