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General NPI Number Information
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NPI Number | 1679301196
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Entity Type | Individual
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Provider Name | MIKAELA GUERTIN APRN
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Gender | Female
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Dates
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Enumeration Date | 07/25/2024
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 19 DODGE ST STE B
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City | BEVERLY
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State | MA
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Zip | 01915-1705
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Country | US
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Telephone | 915-833-8444
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Fax |
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Provider Business Mailing Address
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Address Line | 19 DODGE ST STE B
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City | BEVERLY
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State | MA
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Zip | 01915-1705
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Country | US
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Telephone | 781-328-6542
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1169707
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License Number State | TX
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