Healthcare Provider Details

I. General information

NPI: 1982248506
Provider Name (Legal Business Name): NICOLE PERHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HUNTERS LN
LYMAN ME
04002-7365
US

IV. Provider business mailing address

PO BOX 962
ALFRED ME
04002-0962
US

V. Phone/Fax

Practice location:
  • Phone: 207-590-1407
  • Fax:
Mailing address:
  • Phone: 207-590-1407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN51564
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: