Healthcare Provider Details

I. General information

NPI: 1265271811
Provider Name (Legal Business Name): BREANNA HAMBY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 UNION ST
BANGOR ME
04401-3060
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 207-404-8100
  • Fax:
Mailing address:
  • Phone: 207-404-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP241282
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: