Healthcare Provider Details

I. General information

NPI: 1568846236
Provider Name (Legal Business Name): ANDREW HILTY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BIRCH ST
LEWISTON ME
04240
US

IV. Provider business mailing address

PO BOX 7291
LEWISTON ME
04243-7291
US

V. Phone/Fax

Practice location:
  • Phone: 207-753-5400
  • Fax: 207-786-0489
Mailing address:
  • Phone: 207-777-8553
  • Fax: 207-777-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60555984
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60555984
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP151032
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: