MEDICARE: MRS. SHANNON MARIE FLEWELLING AGACNP-BC

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	CNP221476	ME
2	363LA2100X	Acute Care Nurse Practitioner	CNP221476	ME

General Provider Information

NPI Number	:	1306565106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON MARIE FLEWELLING AGACNP-BC

Provider Business Mailing Address
First Line	:	225 GORHAM RD STE 200
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2462
Country	:	US
Telephone Number	:	207-400-8891
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 GREEN HILL RD
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-2810
Country	:	US
Telephone Number	:	207-764-9406
Fax Number	:

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

Provider Enumeration Date	:	08/24/2022
Last Update Date	:	09/22/2024

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