Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT787 | ME |
NPI | 1346320074 |
---|---|
Provider Name | Nicole C Shipp |
First Address | Freeport, ME 04032-5824 |
Second Address | Brunswick, ME 04011-3359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 07/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
337660099 | (05) | ME |
U45685 | (02) | ME |