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General NPI Number Information
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NPI Number | 1700050390
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Entity Type | Organization
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Legal Business Name | MAINE SCHOOL ADMINISTRATIVE DISTRICT #75
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 73 EAGLES WAY MT. ARARAT HIGH SCHOOL
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City | TOPSHAM
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State | ME
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Zip | 04086-1239
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Country | US
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Telephone | 207-729-2951
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Fax | 207-725-0143
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Provider Business Mailing Address
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Address Line | 73 EAGLES WAY EAGLES NEST, MT. ARARAT HIGH SCHOOL
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City | TOPSHAM
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State | ME
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Zip | 04086-1239
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Country | US
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Telephone | 207-729-2951
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Fax | 207-725-0143
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LORI A BRODSKY
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Credential | FNP
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Telephone | 207-729-2951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | R047235
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License Number State | ME
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