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General NPI Number Information
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NPI Number | 1790725273
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Entity Type | Individual
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Provider Name | TAMMY FORTIER N.P.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 59 BANGOR ST
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City | HOULTON
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State | ME
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Zip | 04730-1740
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Country | US
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Telephone | 207-528-2285
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Fax | 207-528-2880
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Provider Business Mailing Address
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Address Line | PO BOX 500
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City | PATTEN
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State | ME
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Zip | 04765-0500
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Country | US
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Telephone | 207-528-2285
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Fax | 207-528-2880
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R048589
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License Number State | ME
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