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General NPI Number Information
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NPI Number | 1336342955
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Entity Type | Individual
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Provider Name | COLLEEN MAYO
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Gender | Female
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Dates
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Enumeration Date | 06/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 655 MAIN ST
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City | SACO
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State | ME
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Zip | 04072-1543
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Country | US
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Telephone | 207-294-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 124 ELMER ST
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City | ELMER
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State | NJ
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Zip | 08318-2228
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Country | US
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Telephone | 865-358-3242
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00078700
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License Number State | NJ
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