Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP081965 | ME |
NPI | 1013161066 |
---|---|
Provider Name | Mr. Miles Macguffin Brookes |
First Address | Waterville, ME 04901-5173 |
Second Address | Leeds, ME 04263-3418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 15/04/2019 |