Provider Demographics
NPI:1417114513
Name:NEEDHAM, DOTTIE (APRN)
Entity Type:Individual
Prefix:
First Name:DOTTIE
Middle Name:
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DOTTIE
Other - Middle Name:
Other - Last Name:DITTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:16 PEPPERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2401
Mailing Address - Country:US
Mailing Address - Phone:203-245-7941
Mailing Address - Fax:
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-688-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000732363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics