Provider Demographics
NPI:1043495989
Name:VITALE, MICHELLE BOLLES (MSN, APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BOLLES
Last Name:VITALE
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOWE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5473
Mailing Address - Country:US
Mailing Address - Phone:203-401-0235
Mailing Address - Fax:203-401-0338
Practice Address - Street 1:1 HOWE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5473
Practice Address - Country:US
Practice Address - Phone:203-401-0235
Practice Address - Fax:203-401-0338
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001408363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health