=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417939588
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NADINE EDWARDA CONNOR DNP, MSN, APRN, BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2005
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 WEST RD
-----------------------------------------------------
City | PORTAGE LAKE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04768-8801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-943-5042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 108
-----------------------------------------------------
City | PORTAGE LAKE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04768-0108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-943-5042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CNP221279
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------