Healthcare Provider Details

I. General information

NPI: 1780095786
Provider Name (Legal Business Name): CLAIRE ROSS FNP-C, CWON-AP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 OAK RIDGE RD
DURHAM ME
04222-5199
US

IV. Provider business mailing address

PO BOX 693
FREEPORT ME
04032-0693
US

V. Phone/Fax

Practice location:
  • Phone: 207-865-8283
  • Fax: 207-419-0098
Mailing address:
  • Phone: 207-865-8283
  • Fax: 207-419-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP131066
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: