Healthcare Provider Details

I. General information

NPI: 1811779457
Provider Name (Legal Business Name): CHRISTINE BRUNETTE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MARGINAL WAY
PORTLAND ME
04101-2467
US

IV. Provider business mailing address

360 US HIGHWAY 1 BYP UNIT 102
PORTSMOUTH NH
03801-7105
US

V. Phone/Fax

Practice location:
  • Phone: 207-544-9355
  • Fax: 207-544-7756
Mailing address:
  • Phone: 603-410-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN39887
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: