Provider Demographics
NPI:1285003277
Name:RUBENSTEIN, MIKAELA B (FNP-BC)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:B
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CHURCH HILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:ME
Mailing Address - Zip Code:04263-3418
Mailing Address - Country:US
Mailing Address - Phone:207-524-3501
Mailing Address - Fax:207-524-2093
Practice Address - Street 1:7 MAIN ST
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:ME
Practice Address - Zip Code:04282
Practice Address - Country:US
Practice Address - Phone:207-524-3501
Practice Address - Fax:207-225-2692
Is Sole Proprietor?:No
Enumeration Date:2015-09-19
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH089970-23363LF0000X
MARN2376314363LF0000X
MECNP181050363LF0000X
WVAPRN80837-NP-C363LF0000X
GARN254699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024049OtherGROUP MEDICAID
WVB441OtherGROUP MEDICARE
WVB441OtherGROUP MEDICARE