Basic Information
| Provider Information | |||||||||
| NPI: | 1427705151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIBBY | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 MOUNT HOPE AVE STE 420 | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044015678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079475337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 MOUNT HOPE AVE STE 420 | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044015678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079475337 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2022 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | CNM222002 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.