Healthcare Provider Details

I. General information

NPI: 1275626772
Provider Name (Legal Business Name): SHELLEY MOORE-LITTLEFIELD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAIN STREET
SACO ME
04072
US

IV. Provider business mailing address

357 SOUTH STREET
BIDDEFORD ME
04005
US

V. Phone/Fax

Practice location:
  • Phone: 207-294-3100
  • Fax: 207-286-3709
Mailing address:
  • Phone: 207-282-2765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR023451
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: