Provider Demographics
NPI:1821792334
Name:SIMON-MULRAIN, NATASHA AHANNA (NP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:AHANNA
Last Name:SIMON-MULRAIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-3714
Mailing Address - Country:US
Mailing Address - Phone:617-955-4805
Mailing Address - Fax:
Practice Address - Street 1:79 FOWLER ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-3714
Practice Address - Country:US
Practice Address - Phone:617-955-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG03230073363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology