Healthcare Provider Details

I. General information

NPI: 1609852086
Provider Name (Legal Business Name): STEVEN PETRIN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 JUNE ST
SANFORD ME
04073-2621
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-490-7860
  • Fax: 207-604-7409
Mailing address:
  • Phone: 207-283-7000
  • Fax: 207-282-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP81444
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: