MEDICARE: ANNE MARIE MINGOLELLI N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	150387	MA
2	363LX0106X	Occupational Health Nurse Practitioner	150387	MA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	150387	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	150387	OTHER	MA	LICENSE

General Provider Information

NPI Number	:	1063530970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE MARIE MINGOLELLI N.P.

Provider Business Mailing Address
First Line	:	178 KING PHILIP ST
Second Line	:
City	:	WEYMOUTH
State	:	MA
Zip	:	02190-1134
Country	:	US
Telephone Number	:	617-306-1406
Fax Number	:	781-735-5537

Provider Business Practice Location Address
First Line	:	160 OLD DERBY ST STE 457
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4062
Country	:	US
Telephone Number	:	781-837-8833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	05/05/2021

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