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General NPI Number Information
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NPI Number | 1578179156
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Entity Type | Individual
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Provider Name | WILLIAM BORTOLOTTI FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/19/2020
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 79 WASHINGTON AVE
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City | NORTH HAVEN
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State | CT
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Zip | 06473-1704
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Country | US
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Telephone | 203-800-8008
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Fax |
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Provider Business Mailing Address
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Address Line | 79 WASHINGTON AVE
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City | NORTH HAVEN
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State | CT
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Zip | 06473-1704
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12.009186
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License Number State | CT
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