Healthcare Provider Details

I. General information

NPI: 1821027046
Provider Name (Legal Business Name): CHRISTY H SUVLU WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTY HYDE

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 HARLOW ST
BANGOR ME
04401-4952
US

IV. Provider business mailing address

262 HARLOW ST
BANGOR ME
04401-4952
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-3649
  • Fax:
Mailing address:
  • Phone: 207-973-3649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR034093
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: