Healthcare Provider Details

I. General information

NPI: 1528034592
Provider Name (Legal Business Name): SANDRA J PICARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 POND RD
MANCHESTER ME
04351-3615
US

IV. Provider business mailing address

31 READFIELD UNIT 558
MANCHESTER ME
04351-0558
US

V. Phone/Fax

Practice location:
  • Phone: 207-512-8780
  • Fax: 207-623-3137
Mailing address:
  • Phone: 207-512-8780
  • Fax: 207-623-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP81277
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: