Healthcare Provider Details

I. General information

NPI: 1518345826
Provider Name (Legal Business Name): BRENDA MAILMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CEDAR ST
BANGOR ME
04401-6433
US

IV. Provider business mailing address

42 CEDAR ST
BANGOR ME
04401-6433
US

V. Phone/Fax

Practice location:
  • Phone: 207-922-4525
  • Fax: 207-945-5022
Mailing address:
  • Phone: 207-922-4525
  • Fax: 207-945-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR057946
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: