Healthcare Provider Details

I. General information

NPI: 1033100748
Provider Name (Legal Business Name): MICHELLE L LEITE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST STE 270
DOVER DE
19904-3489
US

IV. Provider business mailing address

200 BANNING ST STE 270
DOVER DE
19904-3489
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-1999
  • Fax:
Mailing address:
  • Phone: 302-401-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010571
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG0000289
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000289
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: