Healthcare Provider Details

I. General information

NPI: 1679681217
Provider Name (Legal Business Name): REBECCA CHANDLER PMHNP CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 FRANKLIN HEALTH CMNS STE A
FARMINGTON ME
04938-6142
US

IV. Provider business mailing address

111 FRANKLIN HEALTH CMNS
FARMINGTON ME
04938-6144
US

V. Phone/Fax

Practice location:
  • Phone: 207-778-0035
  • Fax: 207-778-6879
Mailing address:
  • Phone: 207-778-0035
  • Fax: 207-778-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR033605
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberASO84132
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: