Provider Demographics
NPI:1457560120
Name:MIKKOLA, MARGARET LOUISE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:LOUISE
Last Name:MIKKOLA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NASHOBA RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2313
Mailing Address - Country:US
Mailing Address - Phone:978-264-9040
Mailing Address - Fax:978-938-0782
Practice Address - Street 1:435 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-2334
Practice Address - Country:US
Practice Address - Phone:978-264-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1676133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered