Individual
MICHELLE D HENNEBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
263 STATE ST, SUITE 23, BANGOR, ME 04401-5435
(207) 945-3615
(207) 945-3444
Mailing address
263 STATE ST, SUITE 23, BANGOR, ME 04401-5435
(207) 945-3615
(207) 945-3444
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R037051
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048586
ANTHEM
ME
05
—
255830000
—
ME
Enumeration date
05/16/2006
Last updated
12/17/2009
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