Healthcare Provider Details

I. General information

NPI: 1760102941
Provider Name (Legal Business Name): MICHAEL R IRELAND FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 MAIN ST
KENNEBUNK ME
04043-7021
US

IV. Provider business mailing address

72 MAIN ST
KENNEBUNK ME
04043-7021
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-8810
  • Fax: 207-467-8811
Mailing address:
  • Phone: 207-467-8810
  • Fax: 207-467-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP221487
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: