Healthcare Provider Details

I. General information

NPI: 1083056253
Provider Name (Legal Business Name): ALANA M ROSE FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 NORTHPORT AVE STE 112
BELFAST ME
04915-6096
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 207-505-4163
  • Fax: 207-338-6458
Mailing address:
  • Phone: 207-992-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP131082
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: