Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CR2131 | ME |
NPI | 1447693296 |
---|---|
Provider Name | Dr. Amber Hayes |
First Address | Portland, ME 04103 |
Second Address | Portland, ME 04103-2623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2013 |
Last Update Date | 11/04/2013 |