Healthcare Provider Details

I. General information

NPI: 1912013616
Provider Name (Legal Business Name): SANDRA E ST. GERMAIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 STILLWATER AVENUE ACADIA HOSPITAL CORP.
BANGOR ME
04401
US

IV. Provider business mailing address

P.O. BOX 422 ACADIA HOSPITAL CORP.
BANGOR ME
04402-0422
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-6100
  • Fax: 207-973-6109
Mailing address:
  • Phone: 207-973-6100
  • Fax: 207-973-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number016448
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP81134
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: