Provider Demographics
NPI:1295584423
Name:WILLIAMS, MIKAYLA ROSE (RN)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:ROSE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NORWICH CIR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1440
Mailing Address - Country:US
Mailing Address - Phone:339-221-8874
Mailing Address - Fax:
Practice Address - Street 1:10 NORWICH CIR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1440
Practice Address - Country:US
Practice Address - Phone:339-221-8874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2386359163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health