Healthcare Provider Details

I. General information

NPI: 1487665956
Provider Name (Legal Business Name): KRISTEN PFEIFLE M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 BAXTER BLVD
PORTLAND ME
04101-1823
US

IV. Provider business mailing address

43 BAXTER BLVD
PORTLAND ME
04101-1823
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-6381
  • Fax: 207-775-3378
Mailing address:
  • Phone: 207-775-6381
  • Fax: 207-775-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAP1102
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: