Healthcare Provider Details

I. General information

NPI: 1699399931
Provider Name (Legal Business Name): ABRIANNE EAGERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MEDICAL CENTER DR
BRUNSWICK ME
04011-2652
US

IV. Provider business mailing address

400 S MONMOUTH RD
MONMOUTH ME
04259-7605
US

V. Phone/Fax

Practice location:
  • Phone: 207-373-6000
  • Fax:
Mailing address:
  • Phone: 207-577-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN52576
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: