Healthcare Provider Details

I. General information

NPI: 1871687939
Provider Name (Legal Business Name): DAVID C THAYER FNPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 N MAIN ST
WINTERPORT ME
04496-3414
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 207-223-0965
  • Fax: 207-223-0975
Mailing address:
  • Phone: 207-404-8200
  • Fax: 207-947-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP161174
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: