Healthcare Provider Details

I. General information

NPI: 1194923086
Provider Name (Legal Business Name): SHELLIE HAFER ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 US ROUTE 1
SCARBOROUGH ME
04074-9048
US

IV. Provider business mailing address

175 US ROUTE 1
SCARBOROUGH ME
04074-9048
US

V. Phone/Fax

Practice location:
  • Phone: 207-396-7700
  • Fax: 207-396-7701
Mailing address:
  • Phone: 207-396-7700
  • Fax: 207-396-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP251217
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number063999-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number187432
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number063999-23
License Number StateNH
# 5
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP251217
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: