| NPI | 1346543634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE D HENNEBERRY Vice President 207-907-4311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2010-12-08 |
| Last Update Date | 2010-12-08 |