Individual
MARIE-MICHELE FORTILLUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2201 HEMPSTEAD TPKE, EAST MEADOW, NY 11554-1859
(516) 572-6131
(516) 572-5793
Mailing address
2201 HEMPSTEAD TPKE, EAST MEADOW, NY 11554-1859
(516) 572-6131
(516) 572-5793
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
502964
NY
363LP1700X
Perinatal Nurse Practitioner
F390054
NY
363LW0102X
Women's Health Nurse Practitioner
Primary
F420771
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F420771
WOMEN'S HEALTH NP LICENSE
NY
Enumeration date
10/10/2007
Last updated
10/10/2007
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