Mina R Etedali, RN

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

RN2356171 Issued in MA

Practice address

66 Liberty St
Danvers, MA 01923-3323

Phone

(978) 380-2432

NPI assigned

Feb 13, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beth Israel Lahey Health Primary Care, IncGroup PAC ID 7719291434, 351 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beth Israel Lahey Health Primary Care Inc

  • Clinic/Center
  • Middleboro, MA
  • NPI 1568292423
  Medicare reassignment Care Compare group
• Beth Israel Lahey Health Specialty Care, Inc.

  • Internal Medicine Physician
  • Gloucester, MA
  • NPI 1235147760
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1679270417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 LIBERTY ST",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019233323",
            "telephone_number": "978-380-2432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 LIBERTY ST",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019233323",
            "telephone_number": "978-380-2432"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Vfw Pkwy",
            "address_purpose": "LOCATION",
            "city": "West Roxbury",
            "state": "MA",
            "postal_code": "021324927",
            "country_code": "US",
            "telephone_number": "617-323-7700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "298 Washington St Fl 1",
            "address_purpose": "LOCATION",
            "city": "Gloucester",
            "state": "MA",
            "postal_code": "019304832",
            "country_code": "US",
            "telephone_number": "978-283-2726",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "298 Washington St Fl 4",
            "address_purpose": "LOCATION",
            "city": "Gloucester",
            "state": "MA",
            "postal_code": "019304832",
            "country_code": "US",
            "telephone_number": "978-283-7580",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETEDALI",
        "first_name": "MINA",
        "middle_name": "R",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-13",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2356171",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "RN2356171",
            "primary": true
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "MA",
            "license": "2356171",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE NUMBER",
            "identifier": "RN2356171",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tara Beth Espiritu, OT, ATP
• Essex Integrative Health LLC
• Anneris Estevez, MD
• Sherly Estime
• Elizabeth Estrela, MA
• Eudaldo J. Troncoso, M.D. P.C.
• Haley R Evans
• Kaleigh Evans
• Susan Fagan
• Thomas Fagan

• Family Medicine Physician in Danvers, MA
• Providers in Danvers, MA by specialty
• Family Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.