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General NPI Number Information
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NPI Number | 1568165264
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Entity Type | Individual
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Provider Name | HEATHER LYNNE DEMARK
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Gender | Female
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 417 STATE ST STE 340
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City | BANGOR
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State | ME
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Zip | 04401-6634
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Country | US
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Telephone | 207-973-4949
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Fax | 207-973-4466
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Provider Business Mailing Address
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Address Line | 27 STATE ST STE 52
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City | BANGOR
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State | ME
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Zip | 04401-5113
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Country | US
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Telephone | 651-728-2991
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2732
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License Number State | ME
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