Healthcare Provider Details

I. General information

NPI: 1003996646
Provider Name (Legal Business Name): JUDY SPLITTGERBER PMHNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MILL ST
PRINCETON ME
04668-3344
US

IV. Provider business mailing address

136 MILL ST
PRINCETON ME
04668-3344
US

V. Phone/Fax

Practice location:
  • Phone: 207-796-5503
  • Fax:
Mailing address:
  • Phone: 207-796-5503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP221529
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: