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Individual
LEAH MARIE PROVOST
Active
Individual
LEAH MARIE PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN56408
ME
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP241205
ME
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/21/2023
Last updated
07/10/2024
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