Provider Demographics
NPI:1073210019
Name:AUDET, MELISSA SUE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:AUDET
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SUMNER RD
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:ME
Mailing Address - Zip Code:04263-3927
Mailing Address - Country:US
Mailing Address - Phone:207-514-6575
Mailing Address - Fax:
Practice Address - Street 1:5 CENTRAL MAINE XING
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-6320
Practice Address - Country:US
Practice Address - Phone:207-582-6608
Practice Address - Fax:207-582-2258
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231054363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health