Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | CNP151040 | ME |
NPI | 1053780312 |
---|---|
Provider Name | Elise Scala |
First Address | Saco, ME 04072 |
Second Address | Saco, ME 04072-3251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2015 |
Last Update Date | 03/10/2021 |