Individual
MS. ALISON MOORE TETRAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
17 BISHOP ST, PORTLAND, ME 04103-2659
(207) 835-0488
(207) 835-0358
Mailing address
17 BISHOP ST, PORTLAND, ME 04103-2659
(207) 835-0488
(207) 835-0358
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
68812
ME
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP201021
ME
Other
Enumeration date
11/01/2019
Last updated
11/26/2020
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