Healthcare Provider Details

I. General information

NPI: 1487052536
Provider Name (Legal Business Name): ANDREA MARIE SAQUET RDN, LD, MPHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 UNION STREET SUITE 11
BANGOR ME
04401
US

IV. Provider business mailing address

489 STATE ST
BANGOR ME
04401-6616
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-6383
  • Fax:
Mailing address:
  • Phone: 207-973-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI1225
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: