Healthcare Provider Details

I. General information

NPI: 1497396543
Provider Name (Legal Business Name): DAWN MELISSA CHASE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

IV. Provider business mailing address

66 CEMETERY RD
MONMOUTH ME
04259-7632
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-2136
  • Fax: 207-660-4529
Mailing address:
  • Phone: 207-754-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP191282
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR044470
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: