Active NPI
Natasha Ahanna Simon-Mulrain, NP
- Gerontology Nurse Practitioner
- Dorchester, MA
National Provider Identifier
1821792334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- AG03230073
- Practice address
- 79 Fowler St
Dorchester, MA 02121-3714 - Phone
- (617) 955-4805
- NPI assigned
- Mar 28, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | AG03230073 | MA | Primary |
Addresses
Primary practice location
79 Fowler St
Dorchester, MA 02121-3714
Mailing address
79 Fowler St
Dorchester, MA 02121-3714
Phone (617) 955-4805
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AG03230073 | MA | MD | Gerontology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679961600000",
"number": "1821792334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "79 FOWLER ST",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021213714",
"telephone_number": "617-955-4805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 FOWLER ST",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021213714",
"telephone_number": "617-955-4805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON-MULRAIN",
"first_name": "NATASHA",
"middle_name": "AHANNA",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-28",
"last_updated": "2023-03-28",
"certification_date": "2023-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "MA",
"license": "AG03230073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dorchester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.