Healthcare Provider Details

I. General information

NPI: 1033214804
Provider Name (Legal Business Name): CAREN KACHORIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

866 MAIN ST
SANFORD ME
04073-3530
US

IV. Provider business mailing address

51 US ROUTE 1 STE C
SCARBOROUGH ME
04074-7134
US

V. Phone/Fax

Practice location:
  • Phone: 207-324-9385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR040087
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: