Provider Demographics
NPI:1578610945
Name:LITKE, DEBRA A (RN/NP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:LITKE
Suffix:
Gender:F
Credentials:RN/NP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:CONNOLLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:941 GREAT PLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3031
Mailing Address - Country:US
Mailing Address - Phone:339-777-5554
Mailing Address - Fax:
Practice Address - Street 1:941 GREAT PLAIN AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-3031
Practice Address - Country:US
Practice Address - Phone:339-777-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212645363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health