Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | CNP81911 | ME |
NPI | 1003078080 |
---|---|
Provider Name | Heidi M Roy |
First Address | Scarborough, ME 04074-9701 |
Second Address | Scarborough, ME 04074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 17/08/2012 |