Healthcare Provider Details

I. General information

NPI: 1528098316
Provider Name (Legal Business Name): CONSTANCE M SPRINGER-TRACY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 STATE STREET
BANGOR ME
04401-5609
US

IV. Provider business mailing address

1405 MAIN RD.
CARMEL ME
04419-3411
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-4036
  • Fax: 207-941-4062
Mailing address:
  • Phone: 207-941-4078
  • Fax: 207-941-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR028586
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: