Individual
MARY TONINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 EXECUTIVE PARK, LOUISVILLE, KY 40207-4201
(502) 855-3919
Mailing address
120 EXECUTIVE PARK, LOUISVILLE, KY 40207-4201
(502) 855-3919
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3008576
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000993719
ANTHEM PIN
—
05
—
300009618
—
IN
01
—
4813276
AETNA PIN
—
05
—
7100408830
—
KY
01
—
CS1809600107
CARESOURCE ID
—
Enumeration date
12/29/2014
Last updated
01/30/2019
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