Healthcare Provider Details

I. General information

NPI: 1396397899
Provider Name (Legal Business Name): HOLLIE-ANNE STANWOOD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 STILLWATER AVE
BANGOR ME
04401-3945
US

IV. Provider business mailing address

268 STILLWATER AVE
BANGOR ME
04401-3945
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP19114
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberCNP191147
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: