Healthcare Provider Details

I. General information

NPI: 1689664831
Provider Name (Legal Business Name): NANCY APEL CARROLL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 MAIN ST SUITE 2
SOUTH PORTLAND ME
04106-5447
US

IV. Provider business mailing address

39 WALLACE AVE
SOUTH PORTLAND ME
04106-6143
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-1255
  • Fax: 207-775-1299
Mailing address:
  • Phone: 207-761-0650
  • Fax: 207-761-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP081710
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: