Healthcare Provider Details

I. General information

NPI: 1477371565
Provider Name (Legal Business Name): MYKAYLA JEAN BRESETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ACADEMY ST
PRESQUE ISLE ME
04769-3102
US

IV. Provider business mailing address

193 MAIN ST
VAN BUREN ME
04785-1256
US

V. Phone/Fax

Practice location:
  • Phone: 207-768-4000
  • Fax:
Mailing address:
  • Phone: 207-868-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number85152
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: