Healthcare Provider Details

I. General information

NPI: 1306962956
Provider Name (Legal Business Name): NWE OO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 BARKLEY CIR STE 201
FORT MYERS FL
33907-7518
US

IV. Provider business mailing address

700 8TH AVE W STE 101
PALMETTO FL
34221-4737
US

V. Phone/Fax

Practice location:
  • Phone: 407-620-8775
  • Fax:
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-845-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD067262L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME118929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: