Healthcare Provider Details

I. General information

NPI: 1073862561
Provider Name (Legal Business Name): MICHAELA MARIE MAIONE-BALFORD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 WASHINGTON ST
GLOUCESTER MA
01930-4832
US

IV. Provider business mailing address

298 WASHINGTON ST
GLOUCESTER MA
01930-4832
US

V. Phone/Fax

Practice location:
  • Phone: 978-283-5079
  • Fax: 978-282-1371
Mailing address:
  • Phone: 978-283-5079
  • Fax: 978-282-1371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number282723
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: