MEDICARE: NULIFE WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1215541701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NULIFE WELLNESS

Provider Business Mailing Address
First Line	:	361 POLAND SPRING RD
Second Line	:
City	:	CASCO
State	:	ME
Zip	:	04015-4106
Country	:	US
Telephone Number	:	207-514-3562
Fax Number	:

Provider Business Practice Location Address
First Line	:	759 ROOSEVELT TRL
Second Line	:
City	:	WINDHAM
State	:	ME
Zip	:	04062-5341
Country	:	US
Telephone Number	:	207-514-3562
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	SARA DAYON
Credential	:	NP
Telephone Number	:	207-514-3562

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	10/30/2020

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Directions to “NULIFE WELLNESS ” Practice Location

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