Provider Demographics
NPI:1225542970
Name:CULPO, MIKAYLA E (MSN, CPNP)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:E
Last Name:CULPO
Suffix:
Gender:F
Credentials:MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5711
Mailing Address - Country:US
Mailing Address - Phone:781-216-1650
Mailing Address - Fax:
Practice Address - Street 1:9 HOPE AVE FL BCH4
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-216-1960
Practice Address - Fax:781-216-2540
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2282224363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics