Healthcare Provider Details

I. General information

NPI: 1023887205
Provider Name (Legal Business Name): MICHELLE EVANGELINE BRETON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325D KENNEDY MEMORIAL DR STE 1
WATERVILLE ME
04901-4530
US

IV. Provider business mailing address

325D KENNEDY MEMORIAL DR STE 1
WATERVILLE ME
04901-4530
US

V. Phone/Fax

Practice location:
  • Phone: 207-204-3671
  • Fax:
Mailing address:
  • Phone: 207-465-5815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP231527
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: