Healthcare Provider Details

I. General information

NPI: 1073393435
Provider Name (Legal Business Name): HALEE STOREY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W COLE RD STE 101
BIDDEFORD ME
04005-9431
US

IV. Provider business mailing address

54 MIDDLE RD
CUMBERLAND ME
04021-3706
US

V. Phone/Fax

Practice location:
  • Phone: 207-780-6565
  • Fax:
Mailing address:
  • Phone: 207-592-3065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP231456
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: