Healthcare Provider Details

I. General information

NPI: 1720580046
Provider Name (Legal Business Name): EMILY POULIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CTR
AUGUSTA ME
04330-6719
US

IV. Provider business mailing address

862 BANTON RD
PALERMO ME
04354-6509
US

V. Phone/Fax

Practice location:
  • Phone: 801-935-0014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number7472821-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: