Healthcare Provider Details

I. General information

NPI: 1215183918
Provider Name (Legal Business Name): MICHELE RENEE MCMICHAEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 STATE ST
BANGOR ME
04401-6616
US

IV. Provider business mailing address

88 BEECHWOOD AVE
OLD TOWN ME
04468-9749
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-4032
  • Fax:
Mailing address:
  • Phone: 919-247-6427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number182611
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number182611
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN62456
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA123028
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: