Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CR1903 | ME |
N | 111NI0013X | Independent Medical Examiner | CR1903 | ME |
NPI | 1255567988 |
---|---|
Provider Name | Dr. Erika Kristin Bruns Montemerlo |
First Address | Kennebunkport, ME 04046-6040 |
Second Address | Kennebunk, ME 04043-7759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012630 | (02) | ME |