MEDICARE: MRS. DORENE A DOSTAL-JOHNSON FNP

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	363LF0000X	Family Nurse Practitioner	CNP81264	ME

General Provider Information

NPI Number	:	1407886443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DORENE A DOSTAL-JOHNSON FNP

Provider Business Mailing Address
First Line	:	PO BOX 7291
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04243-7291
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 GRACELAWN RD
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210-6334
Country	:	US
Telephone Number	:	207-333-4799
Fax Number	:	207-333-4767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	11/08/2022

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Directions to “ MRS. DORENE A DOSTAL-JOHNSON FNP” Practice Location

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