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General NPI Number Information
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NPI Number | 1366055519
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Entity Type | Organization
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Legal Business Name | RARE GEM PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 08/27/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 110 MAIN ST STE 1508
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City | SACO
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State | ME
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Zip | 04072-3517
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Country | US
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Telephone | 207-420-2390
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Fax |
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Provider Business Mailing Address
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Address Line | 14 WINGATE DR
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City | PORTLAND
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State | ME
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Zip | 04102-1830
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Country | US
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Telephone | 207-612-1104
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE MILLS
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Credential | APRN
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Telephone | 207-420-2390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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