Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | EC171068 | ME |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD23438 | ME |
NPI | 1205366564 |
---|---|
Provider Name | Olivia Simpson |
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 | 19/06/2017 |
Last Update Date | 10/08/2021 |