Healthcare Provider Details

I. General information

NPI: 1124834973
Provider Name (Legal Business Name): GEORGE STEVENS ACADEMY SBWC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 UNION ST
BLUE HILL ME
04614-5908
US

IV. Provider business mailing address

23 UNION ST
BLUE HILL ME
04614-5908
US

V. Phone/Fax

Practice location:
  • Phone: 207-374-2808
  • Fax:
Mailing address:
  • Phone: 207-374-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREA M LOPEZ
Title or Position: VOLUNTEER-STUDENT HEALTH SERVICES
Credential: RN, CRNP
Phone: 207-610-0127