Healthcare Provider Details

I. General information

NPI: 1568516672
Provider Name (Legal Business Name): MICHAEL JAMES EGAN R.N., PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/16/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOREST AVE SUITE 2A
PORTLAND ME
04101-1541
US

IV. Provider business mailing address

6 INDIAN TRL
PLYMOUTH MA
02360-5414
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-2059
  • Fax:
Mailing address:
  • Phone: 207-475-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2295724
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: