Healthcare Provider Details

I. General information

NPI: 1528224177
Provider Name (Legal Business Name): WENDY Z GIGNOUX FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CLINIC RD ELEANOR WIDENER DIXON MEMORIAL CLINIC
GOULDSBORO ME
04607-4013
US

IV. Provider business mailing address

50 UNION ST MAINE COAST MEMORIAL HOSPITAL
ELLSWORTH ME
04605-1586
US

V. Phone/Fax

Practice location:
  • Phone: 207-963-4066
  • Fax: 207-963-7723
Mailing address:
  • Phone: 207-664-5304
  • Fax: 207-664-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR025584
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: