Healthcare Provider Details

I. General information

NPI: 1194757971
Provider Name (Legal Business Name): ELLEN M QUERY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 STATE ST
BANGOR ME
04401-5609
US

IV. Provider business mailing address

55 KENNARD RD
NEWBURGH ME
04444-4905
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-4036
  • Fax: 207-941-4062
Mailing address:
  • Phone: 207-941-4220
  • Fax: 207-941-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR034227
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: