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NPI Code Detail

MEDICARE: WENDY NILE M.D.

MEDICARE: WENDY NILE M.D.
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
1207Q00000XFamily Medicine Physician014350ME

General Provider Information

NPI Number : 1710963053
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY NILE M.D.
Provider Business Mailing Address
First Line : 1250 FOREST AVE
Second Line :
City : PORTLAND
State : ME
Zip : 04103-1884
Country : US
Telephone Number : 207-878-9610
Fax Number : 207-878-4941
Provider Business Practice Location Address
First Line : 1250 FOREST AVE
Second Line :
City : PORTLAND
State : ME
Zip : 04103-1884
Country : US
Telephone Number : 207-878-9610
Fax Number : 207-878-4941
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 07/08/2007

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