Healthcare Provider Details

I. General information

NPI: 1407802325
Provider Name (Legal Business Name): JANE BUTLER STOCKWOOD MS, FNP-C, CUNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CTR
AUGUSTA ME
04330-6719
US

IV. Provider business mailing address

1 VA CTR
AUGUSTA ME
04330-6719
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-8411
  • Fax: 207-621-4882
Mailing address:
  • Phone: 207-623-8411
  • Fax: 207-621-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WU0100X
TaxonomyUrology Registered Nurse
License NumberR021829
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP81468
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: