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General NPI Number Information
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NPI Number | 1295923738
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Entity Type | Individual
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Provider Name | MARIE-MICHELE FORTILLUS NP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 2201 HEMPSTEAD TPKE
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City | EAST MEADOW
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State | NY
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Zip | 11554-1859
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Country | US
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Telephone | 516-572-6131
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Fax | 516-572-5793
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Provider Business Mailing Address
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Address Line | 2201 HEMPSTEAD TPKE
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City | EAST MEADOW
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State | NY
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Zip | 11554-1859
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Country | US
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Telephone | 516-572-6131
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Fax | 516-572-5793
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 502964
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP1700X
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Taxonomy Name | Perinatal Nurse Practitioner
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License Number | F390054
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | F420771
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License Number State | NY
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