Healthcare Provider Details

I. General information

NPI: 1942353370
Provider Name (Legal Business Name): NANCY A. HONEYCHUCK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 E SANGERVILLE RD
SANGERVILLE ME
04479-3227
US

IV. Provider business mailing address

632 E SANGERVILLE RD
SANGERVILLE ME
04479-3227
US

V. Phone/Fax

Practice location:
  • Phone: 716-361-9167
  • Fax:
Mailing address:
  • Phone: 716-361-9167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2602
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR207225-6
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP2456
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number191177
License Number StateME
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP191177
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: