Healthcare Provider Details

I. General information

NPI: 1972588747
Provider Name (Legal Business Name): NANETTE B SEPIK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BOYNTON ST
EASTPORT ME
04631-1306
US

IV. Provider business mailing address

PO BOX H
EASTPORT ME
04631-0909
US

V. Phone/Fax

Practice location:
  • Phone: 207-853-6001
  • Fax: 207-853-4031
Mailing address:
  • Phone: 207-853-6001
  • Fax: 207-853-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP081636
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: