Individual provider · Type 1 NPI

Ketevan Mikautadze

School Registered Nurse · Long Island City, NY

NPI number 1700766656 Active

Practice location

2811 Queens Plz N
Long Island City, NY 11101-4172

Mailing address

255 Fieldston Ter Apt 3M
Bronx, NY 10471-3064

Specialties and licenses

TaxonomyCodeLicense
School Registered Nurse Primary 163WS0200X725743 (NY)

School Registered Nurse: Definition to come...

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About NPI 1700766656

Ketevan Mikautadze's National Provider Identifier is 1700766656, issued on Sep 3, 2025. The primary taxonomy on file is School Registered Nurse (163WS0200X), and the practice location is in Long Island City, NY. The record was last updated on Sep 3, 2025.