Healthcare Provider Details

I. General information

NPI: 1720904659
Provider Name (Legal Business Name): MIKAYLA RAE MACINTYRE DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TEMPLE ST
NASHUA NH
03060-3483
US

IV. Provider business mailing address

30 TEMPLE ST STE 105
NASHUA NH
03060-2401
US

V. Phone/Fax

Practice location:
  • Phone: 603-880-9880
  • Fax:
Mailing address:
  • Phone: 603-880-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number113087-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: