Healthcare Provider Details

I. General information

NPI: 1679046700
Provider Name (Legal Business Name): ANNA LEE ASHLINE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA LEE ROSSWOODS

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 W COMMERCIAL ST
PORTLAND ME
04102-3905
US

IV. Provider business mailing address

141 W COMMERCIAL ST
PORTLAND ME
04102-3905
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-8411
  • Fax:
Mailing address:
  • Phone: 877-421-8263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08752
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-08752
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: