Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R015503 | ME |
NPI | 1023168580 |
---|---|
Provider Name | Janice M Stilkey |
First Address | Scarborough, ME 04074-9701 |
Second Address | Portland, ME 04102-3103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 01/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30343225 | (05) | NH |
421210099 | (05) | ME |
Q29227 | (02) | ME |