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General NPI Number Information
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NPI Number | 1649615154
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Entity Type | Individual
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Provider Name | MYLAH NICOLE MAHON-DAVENDA NP
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Gender | Female
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Dates
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Enumeration Date | 05/10/2013
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 565 TURNPIKE ST STE 85
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-5936
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Country | US
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Telephone | 978-519-4114
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Fax |
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Provider Business Mailing Address
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Address Line | 141 DAYTON ST
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City | DANVERS
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State | MA
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Zip | 01923-1016
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Country | US
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Telephone | 781-608-1968
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN2277802
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2277802
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN2277802
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License Number State | MA
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