Provider Demographics
NPI:1417318742
Name:CHASE, MIKAYLA (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:
Other - Last Name:CALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-FNP
Mailing Address - Street 1:300 SOUTHBOROUGH DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6914
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:
Practice Address - Street 1:1 HARNOIS AVE
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4392
Practice Address - Country:US
Practice Address - Phone:207-662-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP151080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400306321Medicare PIN
MEE400306323Medicare PIN