Provider Demographics
NPI:1720777113
Name:AITRO, MICHELLE LEE (RN CCM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:AITRO
Suffix:
Gender:F
Credentials:RN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 KAILUA RD APT 4209
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2918
Mailing Address - Country:US
Mailing Address - Phone:808-220-1038
Mailing Address - Fax:888-352-9689
Practice Address - Street 1:455 KAILUA RD APT 4209
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2918
Practice Address - Country:US
Practice Address - Phone:808-220-1038
Practice Address - Fax:888-352-9689
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI63486163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse