Healthcare Provider Details

I. General information

NPI: 1790648624
Provider Name (Legal Business Name): TORI LEE WATTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SUMMER ST
MILLINOCKET ME
04462-1400
US

IV. Provider business mailing address

529 S PATTEN RD
PATTEN ME
04765-3007
US

V. Phone/Fax

Practice location:
  • Phone: 207-538-3700
  • Fax: 207-528-2880
Mailing address:
  • Phone: 207-538-3700
  • Fax: 207-528-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN79593
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: