Healthcare Provider Details

I. General information

NPI: 1386402766
Provider Name (Legal Business Name): ANNETTE FRANCES NELLIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ALBERT LN
GLENBURN ME
04401-1025
US

IV. Provider business mailing address

24 ALBERT LN
GLENBURN ME
04401-1025
US

V. Phone/Fax

Practice location:
  • Phone: 207-944-8266
  • Fax:
Mailing address:
  • Phone: 207-944-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCC998
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMF999
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: