Healthcare Provider Details

I. General information

NPI: 1104907526
Provider Name (Legal Business Name): NANCY L SIROIS CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TOGUS VAMC ONE VA CENTER
AUGUSTA ME
04330
US

IV. Provider business mailing address

325 INGRAHAM MTN RD
AUGUSTA ME
04330-8429
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-8411
  • Fax:
Mailing address:
  • Phone: 207-623-2697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTC831
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: