Healthcare Provider Details

I. General information

NPI: 1487735460
Provider Name (Legal Business Name): HALLIE E PRINCE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 MAINE ST STE A200
BRUNSWICK ME
04011-3310
US

IV. Provider business mailing address

329 MAINE STREET STE H
BRUNSWICK ME
04011
US

V. Phone/Fax

Practice location:
  • Phone: 207-373-4700
  • Fax: 207-373-4710
Mailing address:
  • Phone: 207-729-6162
  • Fax: 207-721-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP081794
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: