Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP081953 | ME |
NPI | 1013020742 |
---|---|
Provider Name | Linda Lee Ohnmacht |
First Address | Waterville, ME 04901-4974 |
Second Address | Waterville, ME 04901-4974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 18/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q64108 | (02) |