Healthcare Provider Details

I. General information

NPI: 1891351789
Provider Name (Legal Business Name): MELISSA KATHLEEN LOWER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 COMMUNITY LN
SOUTHWEST HARBOR ME
04679-4273
US

IV. Provider business mailing address

16 COMMUNITY LN
SOUTHWEST HARBOR ME
04679-4273
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-5630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number168089
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011840
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCNP201118
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: