Healthcare Provider Details

I. General information

NPI: 1104862903
Provider Name (Legal Business Name): PAMELA J.W. NOURSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 W MAIN ST SUITE 700
DOVER FOXCROFT ME
04426-1059
US

IV. Provider business mailing address

891 W MAIN ST SUITE 700
DOVER FOXCROFT ME
04426-1059
US

V. Phone/Fax

Practice location:
  • Phone: 207-564-4466
  • Fax: 207-564-4468
Mailing address:
  • Phone: 207-564-4466
  • Fax: 207-564-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number14885
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: