Healthcare Provider Details

I. General information

NPI: 1639039068
Provider Name (Legal Business Name): EDGEWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 DENNIS ST
EAGLE LAKE ME
04739-3321
US

IV. Provider business mailing address

51 DENNIS ST
EAGLE LAKE ME
04739-3321
US

V. Phone/Fax

Practice location:
  • Phone: 207-492-9332
  • Fax:
Mailing address:
  • Phone: 207-492-9332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: NNENNA OGWO ONU
Title or Position: CEO
Credential: RN BSN
Phone: 207-492-9332