Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | CR820 | ME |
N | 111NX0100X | Occupational Health | CR820 | ME |
NPI | 1033258553 |
---|---|
Provider Name | Andrea Korda-Willerson |
First Address | Portland, ME 04102 |
Second Address | Portland, ME 04102-2120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |