Provider Demographics
NPI:1679108344
Name:ARREDONDO, MIKAELA (ND)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:ARREDONDO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 BROADWAY STE 13
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-4371
Mailing Address - Country:US
Mailing Address - Phone:971-808-3479
Mailing Address - Fax:855-955-3928
Practice Address - Street 1:884 BROADWAY STE 13
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-4371
Practice Address - Country:US
Practice Address - Phone:971-808-3479
Practice Address - Fax:855-955-3928
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4297175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath