MEDICARE: MRS. ELIZABETH MAE INCANNELLA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	CNP201145	ME

General Provider Information

NPI Number	:	1275145393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH MAE INCANNELLA FNP

Provider Business Mailing Address
First Line	:	37 PALMER ST STE 2
Second Line	:
City	:	CALAIS
State	:	ME
Zip	:	04619-1341
Country	:	US
Telephone Number	:	207-454-9516
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 PALMER ST STE 2
Second Line	:
City	:	CALAIS
State	:	ME
Zip	:	04619-1341
Country	:	US
Telephone Number	:	207-454-9516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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