Healthcare Provider Details

I. General information

NPI: 1154098614
Provider Name (Legal Business Name): MICHELLE LOUISE BRUMAGHIM PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 GREAT RD STE G1
ACTON MA
01720-4766
US

IV. Provider business mailing address

372 WEST ST STE 102
KEENE NH
03431-2412
US

V. Phone/Fax

Practice location:
  • Phone: 978-679-1200
  • Fax: 978-486-4037
Mailing address:
  • Phone: 603-338-0033
  • Fax: 603-924-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number068114-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPENDING
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2340668
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: