Healthcare Provider Details

I. General information

NPI: 1639088248
Provider Name (Legal Business Name): DORIS INNA MYLENION FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GENERAL ST
LAWRENCE MA
01841-2997
US

IV. Provider business mailing address

1 WINSLOW ST
EVERETT MA
02149-2006
US

V. Phone/Fax

Practice location:
  • Phone: 978-683-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2303510
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08260488
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026075710
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: