Healthcare Provider Details

I. General information

NPI: 1083120042
Provider Name (Legal Business Name): KATHERINE QUATRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 BRIGHTON AVE
PORTLAND ME
04102-1060
US

IV. Provider business mailing address

949 BRIGHTON AVE
PORTLAND ME
04102-1060
US

V. Phone/Fax

Practice location:
  • Phone: 207-780-1070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number28559
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT593
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: