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General NPI Number Information
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NPI Number | 1124834973
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Entity Type | Organization
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Legal Business Name | GEORGE STEVENS ACADEMY SBWC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 23 UNION ST
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City | BLUE HILL
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State | ME
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Zip | 04614-5908
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Country | US
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Telephone | 207-374-2808
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Fax |
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Provider Business Mailing Address
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Address Line | 23 UNION ST
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City | BLUE HILL
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State | ME
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Zip | 04614-5908
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Country | US
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Telephone | 207-374-2808
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Fax |
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Authorized Official
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Title or Position | VOLUNTEER-STUDENT HEALTH SERVICES
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Name | ANDREA M LOPEZ
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Credential | RN, CRNP
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Telephone | 207-610-0127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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