Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R040087 | ME |
NPI | 1033214804 |
---|---|
Provider Name | Caren Kachoris |
First Address | Scarborough, ME 04074-7134 |
Second Address | Sanford, ME 04073-3530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 26/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S60711 | (02) | ME |