Healthcare Provider Details

I. General information

NPI: 1306768536
Provider Name (Legal Business Name): MILLY MUKASA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CUMMINGS PARK STE 6625
WOBURN MA
01801-6528
US

IV. Provider business mailing address

400 W CUMMINGS PARK STE 6625
WOBURN MA
01801-6528
US

V. Phone/Fax

Practice location:
  • Phone: 508-816-0471
  • Fax:
Mailing address:
  • Phone: 508-816-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2331302
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: