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General NPI Number Information
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NPI Number | 1972924561
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Entity Type | Individual
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Provider Name | PRECIOUS SHENANDOAH DEAN PA
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Gender | Female
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Dates
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Enumeration Date | 12/27/2013
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Last Update Date | 01/16/2016
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Provider Practice Location Address
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Address Line | 331 MAINE ST SUITE 23
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City | BRUNSWICK
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State | ME
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Zip | 04011-3358
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Country | US
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Telephone | 207-729-0134
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Fax | 207-729-6626
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Provider Business Mailing Address
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Address Line | 331 MAINE ST SUITE 23
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City | BRUNSWICK
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State | ME
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Zip | 04011-3358
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Country | US
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Telephone | 207-729-0134
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Fax | 207-729-6626
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 017412
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License Number State | NY
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