Healthcare Provider Details

I. General information

NPI: 1770736159
Provider Name (Legal Business Name): MICHELLE TIFFANY LETENDRE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 JAMES ST STE 253
WORCESTER MA
01603-1038
US

IV. Provider business mailing address

70 JAMES ST STE 253
WORCESTER MA
01603-1038
US

V. Phone/Fax

Practice location:
  • Phone: 508-578-2010
  • Fax: 508-578-2012
Mailing address:
  • Phone: 508-578-2010
  • Fax: 508-578-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number205174
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number205174
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number002769
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number205174
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: