Healthcare Provider Details

I. General information

NPI: 1922508902
Provider Name (Legal Business Name): ALISSA GREGERSEN AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 NORTH ST
WATERVILLE ME
04901-4974
US

IV. Provider business mailing address

149 NORTH ST
WATERVILLE ME
04901-4974
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-1307
  • Fax: 207-872-1302
Mailing address:
  • Phone: 207-872-1307
  • Fax: 207-872-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberLP-0000239
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0000239
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP251909
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: