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General NPI Number Information
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NPI Number | 1215721246
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Entity Type | Organization
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Legal Business Name | WHITE ELM DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 8 ELM ST STE 3
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City | GORHAM
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State | ME
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Zip | 04038-1506
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Country | US
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Telephone | 207-303-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 36 RITZ FARM RD
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City | GORHAM
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State | ME
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Zip | 04038-2296
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Country | US
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Telephone | 207-303-8011
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Fax |
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Authorized Official
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Title or Position | OWNER/FAMILY NURSE PRACTITIONER
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Name | MS. RACHEL ROSE MILLER
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Credential | MSN, APRN, FNP-C
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Telephone | 512-661-9796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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