Provider Demographics
NPI:1194957118
Name:GITTENS, WILLIS C (CNM, FNP-C)
Entity type:Individual
Prefix:
First Name:WILLIS
Middle Name:C
Last Name:GITTENS
Suffix:
Gender:F
Credentials:CNM, FNP-C
Other - Prefix:
Other - First Name:WILLIS
Other - Middle Name:C
Other - Last Name:GITTENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM, FNP-C
Mailing Address - Street 1:127 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-5245
Mailing Address - Country:US
Mailing Address - Phone:516-483-1724
Mailing Address - Fax:516-483-1724
Practice Address - Street 1:127 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-5245
Practice Address - Country:US
Practice Address - Phone:516-483-1724
Practice Address - Fax:516-483-1724
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYFOO1212367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife