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General NPI Number Information
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NPI Number | 1114279833
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Entity Type | Individual
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Provider Name | DANIELLE VAFIADES ACNP
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Gender | Female
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 12/23/2016
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Provider Practice Location Address
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Address Line | 417 STATE ST SUITE 421
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City | BANGOR
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State | ME
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Zip | 04401-6630
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Country | US
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Telephone | 207-973-5293
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Fax |
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Provider Business Mailing Address
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Address Line | 43 WHITING HILL RD SUITE 300
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City | BREWER
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State | ME
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Zip | 04412-1005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | CNP121094
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License Number State | ME
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