Healthcare Provider Details

I. General information

NPI: 1720730781
Provider Name (Legal Business Name): MICHELE WHITE RN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALDWELL RD
AUGUSTA ME
04330-5739
US

IV. Provider business mailing address

41 COTTAGE RD
WINTHROP ME
04364-3928
US

V. Phone/Fax

Practice location:
  • Phone: 207-213-2037
  • Fax: 207-621-1107
Mailing address:
  • Phone: 207-931-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR038899
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: