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NPI Code Detail

MEDICARE: WANDA WILLETT C.N.A.

MEDICARE: WANDA WILLETT C.N.A.
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
1376K00000XNurse's Aide

General Provider Information

NPI Number : 1548206238
Entity Type Code : Individual
Provider Name (Legal Business Name) : WANDA WILLETT C.N.A.
Provider Business Mailing Address
First Line : PO BOX 500
Second Line :
City : PATTEN
State : ME
Zip : 04765-0500
Country : US
Telephone Number : 207-528-2285
Fax Number : 207-528-2880
Provider Business Practice Location Address
First Line : 30 HOULTON ST
Second Line :
City : PATTEN
State : ME
Zip : 04765-3035
Country : US
Telephone Number : 207-528-2285
Fax Number : 207-528-2880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 07/08/2007

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