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General NPI Number Information
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NPI Number | 1467051185
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Entity Type | Organization
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Legal Business Name | AGAPE MEDICAL GROUP
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 46 BETTON ST STE 204
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City | BREWER
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State | ME
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Zip | 04412-2636
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Country | US
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Telephone | 207-951-0423
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Fax | 207-544-5107
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Provider Business Mailing Address
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Address Line | 203 MANN HILL RD
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City | HOLDEN
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State | ME
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Zip | 04429-6230
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Country | US
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Telephone | 207-951-0423
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | AUTEUM LAKE
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Credential | NP-C
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Telephone | 207-951-0423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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