Healthcare Provider Details

I. General information

NPI: 1194338871
Provider Name (Legal Business Name): MIA CHRISTINE GILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 13TH ST APT 105
CHARLESTOWN MA
02129-2065
US

IV. Provider business mailing address

27 PARK ST
HYANNIS MA
02601-5203
US

V. Phone/Fax

Practice location:
  • Phone: 267-229-6536
  • Fax:
Mailing address:
  • Phone: 508-862-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2328764
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2328764
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2328764
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: