Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 014035 | ME |
NPI | 1023148509 |
---|---|
Provider Name | Stephanie Boggs |
First Address | Lewiston, ME 04240-7027 |
Second Address | Lewiston, ME 04240-7027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 28/12/2009 |