Provider Demographics
NPI:1770736159
Name:LETENDRE, MICHELLE TIFFANY (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TIFFANY
Last Name:LETENDRE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 JAMES ST STE 253
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1038
Mailing Address - Country:US
Mailing Address - Phone:508-578-2010
Mailing Address - Fax:508-578-2012
Practice Address - Street 1:70 JAMES ST STE 253
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1038
Practice Address - Country:US
Practice Address - Phone:508-578-2010
Practice Address - Fax:508-578-2012
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205174163WL0100X, 363LN0000X, 363LP2300X
CT002769363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care