Healthcare Provider Details

I. General information

NPI: 1689592016
Provider Name (Legal Business Name): NICOLE HENSON AGAC-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 STRAWBERRY AVE
LEWISTON ME
04240-5941
US

IV. Provider business mailing address

362 CROWLEY RD
SABATTUS ME
04280-4608
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-7740
  • Fax:
Mailing address:
  • Phone: 207-312-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP261344
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: