Healthcare Provider Details

I. General information

NPI: 1134121114
Provider Name (Legal Business Name): DONNA BILODEAU F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 RAILROAD SQ KENNEBEC FAMILY PRACTICE
WATERVILLE ME
04901-6139
US

IV. Provider business mailing address

13 RAILROAD SQ KENNEBEC FAMILY PRACTICE
WATERVILLE ME
04901-6139
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-6869
  • Fax: 207-872-7910
Mailing address:
  • Phone: 207-872-6869
  • Fax: 207-872-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP081530
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: