MEDICARE: AROOSTOOK COUNTY ACTION PROGRAM

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	363LW0102X	Women's Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1041019	OTHER	ME	AETNA HMO
2	011804	OTHER	ME	ANTHEM
3	5059615	OTHER	ME	AETNA NHMO

General Provider Information

NPI Number	:	1215910765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AROOSTOOK COUNTY ACTION PROGRAM

Provider Business Mailing Address
First Line	:	771 MAIN ST
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-2201
Country	:	US
Telephone Number	:	207-768-3056
Fax Number	:	207-768-3022

Provider Business Practice Location Address
First Line	:	169 ACADEMY ST
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-3167
Country	:	US
Telephone Number	:	207-768-3062
Fax Number	:	207-768-3057

Authorized Official
Title or Position	:	CLINIC COORDINATOR
Name	:	LINDA MOUNTAIN
Credential	:
Telephone Number	:	207-768-3056

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	08/22/2020

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Directions to “AROOSTOOK COUNTY ACTION PROGRAM ” Practice Location

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