MEDICARE: MS. ANGELA DELVECCHIO 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	R041588	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RO41588	OTHER	ME	LICENSE

General Provider Information

NPI Number	:	1871689257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA DELVECCHIO FNP

Provider Business Mailing Address
First Line	:	322 MAIN ST
Second Line	:	CADILLAC FAMILY PRACTICE
City	:	BAR HARBOR
State	:	ME
Zip	:	04609-1637
Country	:	US
Telephone Number	:	207-288-5119
Fax Number	:	207-288-8449

Provider Business Practice Location Address
First Line	:	322 MAIN ST
Second Line	:	CADILLAC FAMILY PRACTICE
City	:	BAR HARBOR
State	:	ME
Zip	:	04609-1637
Country	:	US
Telephone Number	:	207-288-5119
Fax Number	:	207-288-8449

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	03/06/2013

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