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General NPI Number Information
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NPI Number | 1306483961
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Entity Type | Individual
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Provider Name | KEIKO MARY IDA KURITA FNP
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Gender | Female
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Dates
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Enumeration Date | 12/03/2019
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 15 ANCHOR DR STE 202
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City | ROCKPORT
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State | ME
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Zip | 04856-3848
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Country | US
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Telephone | 207-301-5800
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Fax | 207-207-3015
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Provider Business Mailing Address
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Address Line | 978 PINNACLE RD
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City | LIBERTY
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State | ME
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Zip | 04949-3535
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Country | US
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Telephone | 831-239-6971
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Fax | 207-207-3015
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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 | CNP191238
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License Number State | ME
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