Healthcare Provider Details

I. General information

NPI: 1457310310
Provider Name (Legal Business Name): PATRICIA NURSE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 MAIN ST
BINGHAM ME
04920
US

IV. Provider business mailing address

237 MAIN ST PO BOX 746
BINGHAM ME
04920
US

V. Phone/Fax

Practice location:
  • Phone: 207-672-4187
  • Fax: 207-672-3641
Mailing address:
  • Phone: 207-672-4187
  • Fax: 207-672-3641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR016052
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: