Kristen Mickkelsen Pmhnp Bc LLC
Nurse Practitioner, Psych/Mental Health in Portland, ME. Organization (NPI-2).
NPI number1528502002
StatusActive
Last updated in NPPESDec 19, 2016
Details
- NPI
- 1528502002
- Entity type
- Organization (NPI-2)
- Legal business name
- Kristen Mickkelsen Pmhnp Bc LLC
- Organization subpart
- No
- Enumeration date
- Dec 19, 2016
- Last updated
- Dec 19, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | CNP121069 | ME | Yes |
Practice location
1321 Washington AveSuite 304
Portland, ME 04103-3636
Phone 207-536-3088 · Fax 207-536-3092
Mailing address
106 Sunset RdFalmouth, ME 04105-2490
Phone 207-536-3088 · Fax 207-536-3092
Authorized official
Kristin A Mikkelsen
Owner
2075363088
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