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General NPI Number Information
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NPI Number | 1225809429
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Entity Type | Individual
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Provider Name | CHRISTIAN MCGOWAN
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Gender | Male
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 121 MAIN ST
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City | FAIRFIELD
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State | ME
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Zip | 04937-1528
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Country | US
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Telephone | 207-859-3165
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Fax |
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Provider Business Mailing Address
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Address Line | 3 MCARTHUR AVE
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City | LEWISTON
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State | ME
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Zip | 04240-5124
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Country | US
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Telephone | 207-440-7496
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP241003
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License Number State | ME
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