Healthcare Provider Details

I. General information

NPI: 1174820419
Provider Name (Legal Business Name): KRISTIN NASON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 WEST RD
WATERBORO ME
04087-3209
US

IV. Provider business mailing address

86 WEST RD
WATERBORO ME
04087-3209
US

V. Phone/Fax

Practice location:
  • Phone: 207-247-3141
  • Fax:
Mailing address:
  • Phone: 207-247-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC5408
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: