Healthcare Provider Details

I. General information

NPI: 1720493539
Provider Name (Legal Business Name): FERDUS AWALI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 STRAWBERRY AVE. APT#3
LEWISTON ME
04240
US

IV. Provider business mailing address

93 STRAWBERRY AVE APT 3
LEWISTON ME
04240-3248
US

V. Phone/Fax

Practice location:
  • Phone: 207-344-9221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN63448
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: