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General NPI Number Information
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NPI Number | 1205541992
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Entity Type | Organization
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Legal Business Name | PEARL PELVIC HEALTH, LLC
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 291 ALFRED ST STE 3
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City | BIDDEFORD
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State | ME
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Zip | 04005-3387
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Country | US
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Telephone | 207-405-3655
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Fax |
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Provider Business Mailing Address
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Address Line | 54 WILDWOOD DR
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City | SACO
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State | ME
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Zip | 04072-2234
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Country | US
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Telephone | 207-405-3655
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA DELORME
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Credential |
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Telephone | 207-405-3655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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