Healthcare Provider Details

I. General information

NPI: 1972557056
Provider Name (Legal Business Name): KATHLEEN C MONTEGUT APRN, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/21/2006
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FOREST FALLS DR STE B2
YARMOUTH ME
04096-6999
US

IV. Provider business mailing address

45 FOREST FALLS DR STE B2
YARMOUTH ME
04096-6999
US

V. Phone/Fax

Practice location:
  • Phone: 207-781-1588
  • Fax: 207-781-1543
Mailing address:
  • Phone: 207-729-0468
  • Fax: 207-729-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR024482
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: