Healthcare Provider Details

I. General information

NPI: 1952732265
Provider Name (Legal Business Name): MICHELLE L LACOMBE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE LYN LACOMBE RN

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
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: 207-947-0366
  • Fax:
Mailing address:
  • Phone: 207-922-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP131112
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP131112
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: