Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 20463 | NH |
Y | 2086S0129X | Vascular Surgeon | MD23596 | ME |
NPI | 1134565492 |
---|---|
Provider Name | Anna Marie Boniakowski |
First Address | Portland, ME 04102-3163 |
Second Address | Portland, ME 04102-3163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2013 |
Last Update Date | 16/06/2020 |