Provider Demographics
NPI:1164500765
Name:MITA, ARLENE (CNM)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:MITA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3015
Mailing Address - Country:US
Mailing Address - Phone:978-744-0063
Mailing Address - Fax:
Practice Address - Street 1:585-597 MERRIMACK ST.
Practice Address - Street 2:LCHC
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3908
Practice Address - Country:US
Practice Address - Phone:978-746-7862
Practice Address - Fax:978-275-9890
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239526363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health