Healthcare Provider Details

I. General information

NPI: 1538496112
Provider Name (Legal Business Name): MRS. TERRI LYNN IRELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 OLD COUNTY ROAD
WEST ENFIELD ME
04493
US

IV. Provider business mailing address

140 OLD COUNTY RD. P. O. BOX 119
WEST ENFIELD ME
04493
US

V. Phone/Fax

Practice location:
  • Phone: 207-732-3682
  • Fax:
Mailing address:
  • Phone: 207-732-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: