Healthcare Provider Details

I. General information

NPI: 1275092280
Provider Name (Legal Business Name): NADINE N BOS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NADINE NICKE

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 UNION ST STE 5
BANGOR ME
04401-3057
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-2601
  • Fax:
Mailing address:
  • Phone: 207-404-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberDO3857
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: