Healthcare Provider Details

I. General information

NPI: 1780378190
Provider Name (Legal Business Name): JEANNE ANN MICALE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MARKET SQ
LYNN MA
01905-2420
US

IV. Provider business mailing address

105 WEYLAND CIR
NORTH ANDOVER MA
01845-4935
US

V. Phone/Fax

Practice location:
  • Phone: 781-596-3500
  • Fax:
Mailing address:
  • Phone: 661-904-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2378973
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: