Healthcare Provider Details

I. General information

NPI: 1972811859
Provider Name (Legal Business Name): MICHELLE E KILLINGSWORTH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CHURCH ST SUITE 204
EAST HARTFORD CT
06108-3720
US

IV. Provider business mailing address

87 CHURCH ST SUITE 204
EAST HARTFORD CT
06108-3720
US

V. Phone/Fax

Practice location:
  • Phone: 888-607-0047
  • Fax: 888-690-0088
Mailing address:
  • Phone: 888-607-0047
  • Fax: 888-690-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number00345
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: