Healthcare Provider Details

I. General information

NPI: 1720300049
Provider Name (Legal Business Name): AMY KING RN, WCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 ACADEMY ST SUITE 1C
PRESQUE ISLE ME
04769-3102
US

IV. Provider business mailing address

PO BOX 151
PRESQUE ISLE ME
04769-0151
US

V. Phone/Fax

Practice location:
  • Phone: 207-768-4457
  • Fax: 207-768-4456
Mailing address:
  • Phone: 207-768-4457
  • Fax: 207-768-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR052478
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: