Healthcare Provider Details

I. General information

NPI: 1871088914
Provider Name (Legal Business Name): AMBER LEE WILLEY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 HOGAN RD
BANGOR ME
04401-3626
US

IV. Provider business mailing address

659 HOGAN RD
BANGOR ME
04401-3626
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-0400
  • Fax: 207-973-1881
Mailing address:
  • Phone: 207-973-1881
  • Fax: 207-973-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP181105
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: