Provider Demographics
NPI:1700901170
Name:TOMASETTI, BEVERLY BARONE (NP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:BARONE
Last Name:TOMASETTI
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 1:225 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1921
Mailing Address - Country:US
Mailing Address - Phone:570-342-7864
Mailing Address - Fax:570-342-7119
Practice Address - Street 1:225 PENN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1921
Practice Address - Country:US
Practice Address - Phone:570-342-7864
Practice Address - Fax:570-342-7119
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005863B363LA2200X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist