Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO2535 | ME |
N | 207Q00000X | Family Doctor | DO2535 | ME |
NPI | 1356608368 |
---|---|
Provider Name | Korrie B Beverley-Waters |
First Address | Saco, ME 04072-1543 |
Second Address | Saco, ME 04072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2012 |
Last Update Date | 15/08/2018 |