Provider Demographics
NPI:1578179156
Name:BORTOLOTTI, WILLIAM (FNP-BC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BORTOLOTTI
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:GUILHERME
Other - Middle Name:
Other - Last Name:VIEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:79 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1704
Practice Address - Country:US
Practice Address - Phone:203-800-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-19
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.009186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily