Healthcare Provider Details

I. General information

NPI: 1205951100
Provider Name (Legal Business Name): KERRY T LES RN, WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRY TWITCHELL RN, WHCNP

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-2166
  • Fax: 207-662-6308
Mailing address:
  • Phone: 207-662-2166
  • Fax: 207-662-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR037643
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: