Individual
MIKAELA M PERIBONIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
790 CHURCH ST NE STE 300, MARIETTA, GA 30060-8940
(770) 422-3290
(770) 422-0287
Mailing address
790 CHURCH ST NE STE 300, MARIETTA, GA 30060-8940
(770) 422-3290
(770) 422-0287
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN291729
GA
363LG0600X
Gerontology Nurse Practitioner
Primary
NP291729
GA
Other
Enumeration date
09/19/2022
Last updated
11/20/2025
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