Healthcare Provider Details

I. General information

NPI: 1740199793
Provider Name (Legal Business Name): TAYLOR WIENCKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 WHITTEN RD
AUGUSTA ME
04330-6019
US

IV. Provider business mailing address

3 COFFIN POND RD
FREEPORT ME
04032-6527
US

V. Phone/Fax

Practice location:
  • Phone: 207-466-2400
  • Fax:
Mailing address:
  • Phone: 207-837-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP261787
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: