Healthcare Provider Details

I. General information

NPI: 1396265492
Provider Name (Legal Business Name): BETTY ANN SIROIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 MAIN ST
NORWAY ME
04268-5664
US

IV. Provider business mailing address

181 MAIN ST
NORWAY ME
04268-5664
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-6057
  • Fax: 207-743-2531
Mailing address:
  • Phone: 207-743-5933
  • Fax: 207-743-2531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN35899
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN35899
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: