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General NPI Number Information
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NPI Number | 1720106362
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Entity Type | Organization
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Legal Business Name | KENNEBEC VALLEY COMMUNITY ACTION PROGRAM
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 101 WATER ST SUITE 204
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City | WATERVILLE
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State | ME
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Zip | 04901-6339
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Country | US
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Telephone | 207-859-1638
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Fax | 207-859-1696
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Provider Business Mailing Address
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Address Line | 97 WATER ST
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City | WATERVILLE
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State | ME
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Zip | 04901-6339
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Country | US
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Telephone | 207-859-1638
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Fax | 207-859-1696
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Authorized Official
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Title or Position | FPNP
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Name | MISS COLLEEN TAYLOR
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Credential | FPNP
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Telephone | 207-859-1639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | R013536
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License Number State | ME
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