Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CR1590 | ME |
NPI | 1588613608 |
---|---|
Provider Name | Dr. Caitlin M. Morrisroe |
First Address | Portland, ME 04112-7640 |
Second Address | Portland, ME 04101-6420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 23/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
158-861-3608 | (02) | ME |