Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CR598 | ME |
NPI | 1558582593 |
---|---|
Provider Name | Dr. J. Stephen Anderson |
First Address | Winslow, ME 04901-0788 |
Second Address | Winslow, ME 04901-0788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |