Provider Demographics
NPI:1376614859
Name:KRAVITZ, MIRIAM (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:KRAVITZ
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:MRS
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:KRAVITZ-MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3 NAMSKAKET ROAD
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653
Mailing Address - Country:US
Mailing Address - Phone:508-255-4050
Mailing Address - Fax:888-448-6765
Practice Address - Street 1:3 NAMSKAKET ROAD
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653
Practice Address - Country:US
Practice Address - Phone:508-255-4050
Practice Address - Fax:888-448-6765
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195664363L00000X
MARN/NP195664363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA923778OtherTUFTS HEALTH PLAN
MA3539056OtherCIGNA
MAAA348737OtherHARVARD PILGRIM HEALTH CARE
MA3117341Medicaid