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General NPI Number Information
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NPI Number | 1841105319
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Entity Type | Individual
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Provider Name | CRYSTAL MACGOWN
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Gender | Female
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Dates
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Enumeration Date | 08/18/2026
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Last Update Date | 08/18/2026
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Provider Practice Location Address
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Address Line | 190 BANGOR RD
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City | ELLSWORTH
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State | ME
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Zip | 04605-3258
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Country | US
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Telephone | 207-888-2058
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Fax | 207-888-0025
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Provider Business Mailing Address
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Address Line | 190 BANGOR RD
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City | ELLSWORTH
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State | ME
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Zip | 04605-3258
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Country | US
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Telephone | 207-888-2058
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Fax | 207-888-0025
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN15307
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License Number State | ME
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