1811015803 NPI number — KRISTIN WHITNEY MIKKELSEN M.A.

Table of content: KRISTIN WHITNEY MIKKELSEN M.A. (NPI 1811015803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811015803 NPI number — KRISTIN WHITNEY MIKKELSEN M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIKKELSEN
Provider First Name:
KRISTIN
Provider Middle Name:
WHITNEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREEN
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
WHITNEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811015803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 SCARLETT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BOYLSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01583-1618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-887-1608
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 SCARLETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BOYLSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01583-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-887-1608
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com