Healthcare Provider Details

I. General information

NPI: 1205667334
Provider Name (Legal Business Name): THERESAH MUKASA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2024
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 OAK ST
NORTH BILLERICA MA
01862-1907
US

IV. Provider business mailing address

272 CAMBRIDGE RD APT 31
WOBURN MA
01801-6021
US

V. Phone/Fax

Practice location:
  • Phone: 857-352-9082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2386595
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2386595
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: