=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962398289
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIKAYLA ARDIZZONI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2025
-----------------------------------------------------
Last Update Date | 06/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 157 PAIGE HILL RD
-----------------------------------------------------
City | BRIMFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01010-9779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-343-4175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 159 PAIGE HILL RD
-----------------------------------------------------
City | BRIMFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01010-9779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-343-4175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | RN2335581
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------