Provider Demographics
NPI:1952959785
Name:MICHELLE VAN DUINEN APRN PLLC
Entity type:Organization
Organization Name:MICHELLE VAN DUINEN APRN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DUINEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-245-5811
Mailing Address - Street 1:107 WILCOX RD STE 105
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-2614
Mailing Address - Country:US
Mailing Address - Phone:860-245-5811
Mailing Address - Fax:
Practice Address - Street 1:107 WILCOX RD STE 105
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-2614
Practice Address - Country:US
Practice Address - Phone:860-245-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty