Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD24001 | ME |
NPI | 1063074425 |
---|---|
Provider Name | Dr. Nicole Lauren Lebo |
First Address | Brewer, ME 04412-1006 |
Second Address | Bangor, ME 04401-3073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2019 |
Last Update Date | 03/09/2020 |