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General NPI Number Information
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NPI Number | 1568516672
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Entity Type | Individual
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Provider Name | MICHAEL JAMES EGAN R.N., PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/16/2025
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Provider Practice Location Address
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Address Line | 500 FOREST AVE SUITE 2A
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City | PORTLAND
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State | ME
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Zip | 04101-1541
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Country | US
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Telephone | 207-775-2059
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Fax |
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Provider Business Mailing Address
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Address Line | 6 INDIAN TRL
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City | PLYMOUTH
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State | MA
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Zip | 02360-5414
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Country | US
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Telephone | 207-475-2077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN2295724
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License Number State | MA
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