1093449407 NPI number — MRS. KAITLYN DEBRA PIRTEL CNM, RN, DNP

Table of content: MRS. KAITLYN DEBRA PIRTEL CNM, RN, DNP (NPI 1093449407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093449407 NPI number — MRS. KAITLYN DEBRA PIRTEL CNM, RN, DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIRTEL
Provider First Name:
KAITLYN
Provider Middle Name:
DEBRA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM, RN, DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLAHERTY
Provider Other First Name:
KAITLYN
Provider Other Middle Name:
DEBRA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093449407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 JOHN ST
Provider Second Line Business Mailing Address:
UNIT 213
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-746-4210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 MIX AVE APT 5H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06514-2345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-746-4210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  169473 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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