Healthcare Provider Details

I. General information

NPI: 1093330441
Provider Name (Legal Business Name): STEPHANIE LYNNE MICHAUD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 E MAIN ST
FORT KENT ME
04743-1428
US

IV. Provider business mailing address

194 E MAIN ST
FORT KENT ME
04743-1428
US

V. Phone/Fax

Practice location:
  • Phone: 207-834-3155
  • Fax: 207-834-2949
Mailing address:
  • Phone: 207-834-3155
  • Fax: 207-834-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP201117
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: