Healthcare Provider Details

I. General information

NPI: 1942938758
Provider Name (Legal Business Name): JULIE WARK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HOSPITAL DR
YORK ME
03909-1030
US

IV. Provider business mailing address

15 HOSPITAL DR
YORK ME
03909-1099
US

V. Phone/Fax

Practice location:
  • Phone: 207-351-3733
  • Fax: 207-351-3574
Mailing address:
  • Phone: 207-363-4321
  • Fax: 207-363-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number54695
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: