Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN2328538 | MA |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN2328538 | MA |
NPI | 1003403841 |
---|---|
Provider Name | Mikhaila Cicely Marecki |
First Address | Boston, MA 02215-3668 |
Second Address | Boston, MA 02114-3117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2020 |
Last Update Date | 29/12/2020 |