Healthcare Provider Details

I. General information

NPI: 1316367717
Provider Name (Legal Business Name): SUSAN ANN STORER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MOLYNEAUX RD
CAMEN ME
04843-4003
US

IV. Provider business mailing address

501 MOLYNEAUX RD
CAMDEN ME
04843-4003
US

V. Phone/Fax

Practice location:
  • Phone: 207-542-5853
  • Fax:
Mailing address:
  • Phone: 207-542-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN20246
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: