Provider Demographics
NPI:1295380228
Name:MICHELOTTI, KATHRYN M (DNP APRN FNP-BC CCRN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:MICHELOTTI
Suffix:
Gender:F
Credentials:DNP APRN FNP-BC CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3945
Mailing Address - Country:US
Mailing Address - Phone:973-769-1675
Mailing Address - Fax:
Practice Address - Street 1:264 BOYDEN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3070
Practice Address - Country:US
Practice Address - Phone:973-761-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00944100363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily