1295075463 NPI number — MRS. MICHELLE NELSON GASPAR M.ED

Table of content: MRS. MICHELLE NELSON GASPAR M.ED (NPI 1295075463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295075463 NPI number — MRS. MICHELLE NELSON GASPAR M.ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASPAR
Provider First Name:
MICHELLE
Provider Middle Name:
NELSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELLINGTON
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
NELSON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295075463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94 ADAMS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04429-4169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-222-4837
Provider Business Mailing Address Fax Number:
888-331-5464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
268 STATE ST STE 2-3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-5417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-222-4837
Provider Business Practice Location Address Fax Number:
888-331-5464
Provider Enumeration Date:
02/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH60970859 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: CC5352 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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