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General NPI Number Information
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NPI Number | 1497574610
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Entity Type | Individual
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Provider Name | MIKAYLAH MARIE CLOUTIER
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Gender | Female
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 7301 N 16TH ST STE 102
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City | PHOENIX
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State | AZ
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Zip | 85020
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Country | US
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Telephone | 623-233-0914
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Fax |
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Provider Business Mailing Address
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Address Line | 2624 W 44TH AVE
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City | DENVER
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State | CO
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Zip | 80211-1447
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Country | US
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Telephone | 207-592-4305
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.1000275-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 316403
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License Number State | AZ
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