Provider Demographics
NPI:1457304420
Name:LITWIN, MICHELE NADINE (NP, CARN-AP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:NADINE
Last Name:LITWIN
Suffix:
Gender:F
Credentials:NP, CARN-AP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:NADINE
Other - Last Name:WASHBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357
Mailing Address - Country:US
Mailing Address - Phone:860-691-0873
Mailing Address - Fax:860-691-0876
Practice Address - Street 1:30 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357
Practice Address - Country:US
Practice Address - Phone:860-691-0873
Practice Address - Fax:860-691-0876
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003399363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004269701Medicaid