Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | MD20555 | ME |
NPI | 1164698569 |
---|---|
Provider Name | Pip Hidestrand |
First Address | Brewer, ME 04412-1006 |
Second Address | Bangor, ME 04401-6654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 03/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164698569 | (05) | WI |