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General NPI Number Information
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NPI Number | 1881326791
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Entity Type | Individual
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Provider Name | MICQUE ELLYN MORTELA RN
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Gender | Female
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 161 JACKSON ST
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City | LOWELL
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State | MA
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Zip | 01852-2103
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Country | US
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Telephone | 978-937-9700
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Fax | 978-221-6728
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Provider Business Mailing Address
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Address Line | 12 GAIL RD
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City | MERRIMACK
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State | NH
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Zip | 03054-4556
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Country | US
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Telephone | 978-995-5705
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2291047
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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 | RN2291047
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License Number State | MA
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