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General NPI Number Information
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NPI Number | 1760953319
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Entity Type | Organization
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Legal Business Name | SOUTHERN MAINE WELLNESS WORKS, LLC
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Dates
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Enumeration Date | 12/07/2018
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 1662 POST RD STE B2-A
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City | WELLS
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State | ME
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Zip | 04090-4638
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Country | US
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Telephone | 207-360-2029
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Fax | 207-360-2033
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Provider Business Mailing Address
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Address Line | 1662 POST RD STE B2-A
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City | WELLS
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State | ME
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Zip | 04090-4638
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Country | US
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Telephone | 207-360-2029
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Fax | 207-360-2033
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MRS. GLORIA I OPPEN
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Credential | NP
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Telephone | 978-996-7281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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