Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD10078 | RI |
Y | 2080A0000X | Adolescent Medicine | 49231 | CT |
NPI | 1255307823 |
---|---|
Provider Name | Michelle A Cretella |
First Address | Westerly, RI 02891-3712 |
Second Address | East Lyme, CT 06333-1605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 12/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G98868 | (02) | RI |