Healthcare Provider Details

I. General information

NPI: 1104758655
Provider Name (Legal Business Name): AMANDA LEE KOLLN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 COMMERCE PLZ STE 3A
WINTHROP ME
04364-1562
US

IV. Provider business mailing address

16 COMMERCE PLZ STE 3A
WINTHROP ME
04364-1562
US

V. Phone/Fax

Practice location:
  • Phone: 207-377-2111
  • Fax:
Mailing address:
  • Phone: 207-377-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP261691
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: