Provider Demographics
NPI:1114996808
Name:BELYEA, MICHELLE (PNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:BELYEA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 FODEN ROAD WEST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2327
Mailing Address - Country:US
Mailing Address - Phone:207-828-0361
Mailing Address - Fax:207-874-1483
Practice Address - Street 1:84 MARGINAL WAY
Practice Address - Street 2:SUITE 1000
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2443
Practice Address - Country:US
Practice Address - Phone:207-774-4092
Practice Address - Fax:207-523-8596
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME022759363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner