Healthcare Provider Details

I. General information

NPI: 1992553440
Provider Name (Legal Business Name): PATRICIA ENDSLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SANFORD RD
WELLS ME
04090-5534
US

IV. Provider business mailing address

18 VARNEY ST
LEBANON ME
04027-4133
US

V. Phone/Fax

Practice location:
  • Phone: 207-641-6967
  • Fax:
Mailing address:
  • Phone: 603-767-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN36916
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: