Healthcare Provider Details

I. General information

NPI: 1679312300
Provider Name (Legal Business Name): NICOLE DUBOIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-294-5000
  • Fax: 207-294-5227
Mailing address:
  • Phone: 207-294-5000
  • Fax: 207-294-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3121
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: