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General NPI Number Information
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NPI Number | 1992003685
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Entity Type | Individual
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Provider Name | BONNIE JILL TROUBH PA
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Gender | Female
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 1600 CONGRESS ST
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City | PORTLAND
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State | ME
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Zip | 04102-2143
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Country | US
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Telephone | 207-774-7751
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Fax |
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Provider Business Mailing Address
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Address Line | 35 PADDOCK WAY
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City | FALMOUTH
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State | ME
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Zip | 04105-1305
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Country | US
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Telephone | 207-210-6426
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Fax |
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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 | PA001244
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License Number State | ME
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