Provider Demographics
NPI:1023887205
Name:BRETON, MICHELLE EVANGELINE (PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:EVANGELINE
Last Name:BRETON
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 1:39 SELDEN LN
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-5082
Mailing Address - Country:US
Mailing Address - Phone:207-465-5815
Mailing Address - Fax:
Practice Address - Street 1:841 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8302
Practice Address - Country:US
Practice Address - Phone:844-294-5306
Practice Address - Fax:844-294-5306
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231527363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health