Healthcare Provider Details

I. General information

NPI: 1659505451
Provider Name (Legal Business Name): MAINE CDC PUBLIC HEALTH NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 WATER ST KEY PLZ FL 7 STATE HOUSE STATION # 11
AUGUSTA ME
04333-0011
US

IV. Provider business mailing address

286 WATER ST KEY PLZ FL 7 STATE HOUSE STATION # 11
AUGUSTA ME
04333-0011
US

V. Phone/Fax

Practice location:
  • Phone: 207-287-9025
  • Fax: 207-287-5355
Mailing address:
  • Phone: 207-287-9025
  • Fax: 207-287-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DWIGHT R LITTLEFIELD
Title or Position: PUBLIC HEALTH NURSING CONSULTANT
Credential: RN, MBA
Phone: 207-287-9025