Healthcare Provider Details

I. General information

NPI: 1790253995
Provider Name (Legal Business Name): MICHAEL ROBERT ESPELIN APRN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 DURHAM RD STE 6
MADISON CT
06443-2656
US

IV. Provider business mailing address

PO BOX 321
MADISON CT
06443-0321
US

V. Phone/Fax

Practice location:
  • Phone: 203-745-2368
  • Fax: 928-272-0190
Mailing address:
  • Phone: 203-745-2368
  • Fax: 928-272-0190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7939
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: