MEDICARE: MIKAELA GUERTIN APRN

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	363LF0000X	Family Nurse Practitioner	RN10027150	MA
2	363LF0000X	Family Nurse Practitioner	1169707	TX

General Provider Information

NPI Number	:	1679301196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAELA GUERTIN APRN

Provider Business Mailing Address
First Line	:	19 DODGE ST STE B
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-1705
Country	:	US
Telephone Number	:	781-328-6542
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 DODGE ST STE B
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-1705
Country	:	US
Telephone Number	:	915-833-8444
Fax Number	:

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

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	12/10/2025

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