Healthcare Provider Details

I. General information

NPI: 1881159317
Provider Name (Legal Business Name): BRENDA A NADEAU DEVEAU RN, MHRT-C, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 PALMER ST
CALAIS ME
04619-1300
US

IV. Provider business mailing address

180 ACADEMY ST STE 3
PRESQUE ISLE ME
04769-3183
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-0270
  • Fax: 207-454-0232
Mailing address:
  • Phone: 207-554-2352
  • Fax: 207-554-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN39939
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLS1793
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: