Healthcare Provider Details

I. General information

NPI: 1215507876
Provider Name (Legal Business Name): GAIGE FLEWELLING CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ACADEMY ST
PRESQUE ISLE ME
04769-3102
US

IV. Provider business mailing address

70 GRIFFIN RIDGE RD
MAPLETON ME
04757-4401
US

V. Phone/Fax

Practice location:
  • Phone: 207-768-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN66205
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA213054
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: