Healthcare Provider Details

I. General information

NPI: 1538405139
Provider Name (Legal Business Name): KAITLIN MICHELLE KNAPP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN MICHELLE WALDRON FNP

II. Dates (important events)

Enumeration Date: 12/31/2012
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 FRANKLIN ST
RUMFORD ME
04276-2100
US

IV. Provider business mailing address

431 FRANKLIN ST
RUMFORD ME
04276-2100
US

V. Phone/Fax

Practice location:
  • Phone: 207-364-7831
  • Fax: 207-369-9467
Mailing address:
  • Phone: 207-364-7831
  • Fax: 207-369-9467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP121120
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: