Provider Demographics
NPI:1013161066
Name:BROOKES, MILES MACGUFFIN (PMH-NP)
Entity type:Individual
Prefix:MR
First Name:MILES
Middle Name:MACGUFFIN
Last Name:BROOKES
Suffix:
Gender:M
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 EUSTIS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5173
Mailing Address - Country:US
Mailing Address - Phone:207-873-2136
Mailing Address - Fax:207-872-4522
Practice Address - Street 1:180 CHURCH HILL RD STE 1
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:ME
Practice Address - Zip Code:04263-3418
Practice Address - Country:US
Practice Address - Phone:207-524-3501
Practice Address - Fax:207-524-2093
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081965363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health