Provider Demographics
NPI:1033100748
Name:LEITE, MICHELLE L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:LEITE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PEAR BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-4911
Mailing Address - Country:US
Mailing Address - Phone:302-697-9302
Mailing Address - Fax:
Practice Address - Street 1:200 BANNING ST
Practice Address - Street 2:SUITE 170
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3485
Practice Address - Country:US
Practice Address - Phone:302-674-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP29849Medicare UPIN