Provider Demographics
NPI:1972811859
Name:KILLINGSWORTH, MICHELLE E (CNM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:KILLINGSWORTH
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 1:87 CHURCH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3720
Mailing Address - Country:US
Mailing Address - Phone:888-607-0047
Mailing Address - Fax:888-690-0088
Practice Address - Street 1:87 CHURCH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3720
Practice Address - Country:US
Practice Address - Phone:888-607-0047
Practice Address - Fax:888-690-0088
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00345176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00345OtherSTATE CNM LICENSE
CT008023951Medicaid