Healthcare Provider Details

I. General information

NPI: 1033694427
Provider Name (Legal Business Name): AISHA SAUNDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 AUBURN ST
PORTLAND ME
04103-2103
US

IV. Provider business mailing address

13 ACADEMY PL APT 25
SACO ME
04072-2873
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-3393
  • Fax:
Mailing address:
  • Phone: 207-249-8435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP181249
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: