Basic Information
| Provider Information | |||||||||
| NPI: | 1649366212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILORD | ||||||||
| FirstName: | LA-KEISHA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 WEBSTER ST | ||||||||
| Address2: | STE 8 | ||||||||
| City: | HANOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023391227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817546545 | ||||||||
| FaxNumber: | 7815360016 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 GARLAND STREET | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173947600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 10/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 258012 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.