Healthcare Provider Details

I. General information

NPI: 1295893022
Provider Name (Legal Business Name): CATHERINE WILSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 ATLANTIC HWY
LINCOLNVILLE ME
04849
US

IV. Provider business mailing address

118 NORTHPORT AVE P.O. BOX 287
BELFAST ME
04915-6009
US

V. Phone/Fax

Practice location:
  • Phone: 207-236-4851
  • Fax: 207-236-0776
Mailing address:
  • Phone: 207-338-0990
  • Fax: 207-338-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR047021
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: