Healthcare Provider Details

I. General information

NPI: 1316867831
Provider Name (Legal Business Name): MOLLI JEAN CULLINS AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 CAMPUS DR
SCARBOROUGH ME
04074-7163
US

IV. Provider business mailing address

96 CAMPUS DR
SCARBOROUGH ME
04074-7163
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-9905
  • Fax: 207-396-5600
Mailing address:
  • Phone: 207-885-9905
  • Fax: 207-396-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP261513
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP261513
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberCNP261513
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberCNP261513
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: