Healthcare Provider Details

I. General information

NPI: 1215529847
Provider Name (Legal Business Name): KRISTEN L MICHAUD RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 LAFAYETTE RD STE 204
PORTSMOUTH NH
03801-8864
US

IV. Provider business mailing address

1950 LAFAYETTE RD STE 204
PORTSMOUTH NH
03801-8864
US

V. Phone/Fax

Practice location:
  • Phone: 661-373-3570
  • Fax: 855-351-8707
Mailing address:
  • Phone: 661-373-3570
  • Fax: 855-351-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number043098-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: