Provider Demographics
NPI:1578610945
Name:LITKE, DEBRA A (RN/NP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:LITKE
Suffix:
Gender:F
Credentials:RN/NP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:CONNOLLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 HERRICK ST STE 203
Mailing Address - Street 2:NORTHEAST DERMATOLOGY ASSOCIATES
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2734
Mailing Address - Country:US
Mailing Address - Phone:978-927-5254
Mailing Address - Fax:
Practice Address - Street 1:77 HERRICK ST STE 203
Practice Address - Street 2:NORTHEAST DERMATOLOGY ASSOCIATES
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2734
Practice Address - Country:US
Practice Address - Phone:978-927-5254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212645363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health