Provider Demographics
NPI:1093985970
Name:PIZZA, MICHAEL S (APRN, BC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:PIZZA
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Gender:M
Credentials:APRN, BC
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Mailing Address - Street 1:289 GREAT ROAD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720
Mailing Address - Country:US
Mailing Address - Phone:978-679-1200
Mailing Address - Fax:978-486-4037
Practice Address - Street 1:289 GREAT ROAD
Practice Address - Street 2:SUITE G1
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720
Practice Address - Country:US
Practice Address - Phone:978-679-1200
Practice Address - Fax:978-486-4037
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2021-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA236572163WP0809X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA020860Medicaid