Healthcare Provider Details

I. General information

NPI: 1649366741
Provider Name (Legal Business Name): NANCY O GREEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 PALMER ST
CALAIS ME
04619-1305
US

IV. Provider business mailing address

43 PALMER ST
CALAIS ME
04619-1305
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-3307
  • Fax: 207-454-3988
Mailing address:
  • Phone: 207-454-8150
  • Fax: 207-454-0256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR027181
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: