Healthcare Provider Details

I. General information

NPI: 1114914173
Provider Name (Legal Business Name): VIRGINIA ANN LANOCE APRN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 WILTON RD
FARMINGTON ME
04938-6138
US

IV. Provider business mailing address

672 WILTON ROAD
FARMINGTON ME
04938
US

V. Phone/Fax

Practice location:
  • Phone: 207-778-9531
  • Fax: 207-778-6535
Mailing address:
  • Phone: 207-778-9531
  • Fax: 207-778-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP81292
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: