Individual
MINA R ETEDALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
66 LIBERTY ST, DANVERS, MA 01923-3323
(978) 380-2432
Mailing address
66 LIBERTY ST, DANVERS, MA 01923-3323
(978) 380-2432
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
2356171
MA
207Q00000X
Family Medicine Physician
Primary
RN2356171
MA
363LF0000X
Family Nurse Practitioner
RN2356171
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN2356171
RN LICENSE NUMBER
MA
Enumeration date
02/13/2023
Last updated
04/22/2026
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