Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R020976 | ME |
NPI | 1134287147 |
---|---|
Provider Name | Ms. Ann T Carroll |
First Address | Portland, ME 04102-3134 |
Second Address | Portland, ME 04102-3134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |