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General NPI Number Information
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NPI Number | 1518166636
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Entity Type | Individual
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Provider Name | DEBORAH ANN MARTIN FNP
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Gender | Female
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 11/12/2012
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Provider Practice Location Address
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Address Line | 325E KENNEDY MEMORIAL DR MAINEGENERAL GASTROENTEROLOGY
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City | WATERVILLE
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State | ME
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Zip | 04901-4531
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Country | US
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Telephone | 207-872-2424
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Fax | 207-872-2099
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Provider Business Mailing Address
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Address Line | 325E KENNEDY MEMORIAL DR MAINEGENERAL GASTROENTEROLOGY
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City | WATERVILLE
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State | ME
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Zip | 04901-4531
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Country | US
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Telephone | 207-872-2424
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Fax | 207-872-2099
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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 | R-027780
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP081728
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License Number State | ME
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