Healthcare Provider Details

I. General information

NPI: 1467018861
Provider Name (Legal Business Name): NICHOLE ANN YEATON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 GABRIEL DR
AUGUSTA ME
04330-7852
US

IV. Provider business mailing address

43 GABRIEL DR
AUGUSTA ME
04330-7852
US

V. Phone/Fax

Practice location:
  • Phone: 207-922-9333
  • Fax: 207-778-2041
Mailing address:
  • Phone: 207-922-3222
  • Fax: 207-778-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP191041
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: