Provider Demographics
NPI:1639541808
Name:BASTEY, MONICA ELIZABETH (NNP-BC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ELIZABETH
Last Name:BASTEY
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:ELIZABETH
Other - Last Name:NEVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP, APRN
Mailing Address - Street 1:183 BRACKETT ST # 409
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3857
Mailing Address - Country:US
Mailing Address - Phone:510-409-5369
Mailing Address - Fax:
Practice Address - Street 1:183 BRACKETT ST # 409
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3857
Practice Address - Country:US
Practice Address - Phone:510-409-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME151142363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal