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NPI Code Detail

MEDICARE: TRACY C WITTREICH C.N.M., M.S.N

MEDICARE: TRACY C WITTREICH C.N.M., M.S.N
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367A00000XAdvanced Practice MidwifeLNM 000012CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P2826209OTHEROXFORD WEALTH PLAN
2000012OTHERCONNECTICARE
30Q2742OTHERHEALTHNET
4400000012CT01OTHERANTHEM BLUE CROSS OF CT

General Provider Information

NPI Number : 1518964170
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY C WITTREICH C.N.M., M.S.N
Provider Business Mailing Address
First Line : 675 S MAIN ST
Second Line :
City : CHESHIRE
State : CT
Zip : 06410-3153
Country : US
Telephone Number : 203-250-2125
Fax Number : 203-250-2161
Provider Business Practice Location Address
First Line : 675 S MAIN ST
Second Line :
City : CHESHIRE
State : CT
Zip : 06410-3153
Country : US
Telephone Number : 203-272-1811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 05/22/2008

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