Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 11936 | ME |
NPI | 1013916410 |
---|---|
Provider Name | Nancy Egan |
First Address | Brunswick, ME 04011-2026 |
Second Address | Brunswick, ME 04011-2026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 13/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115270099 | (05) | ME |
B86291 | (02) |