Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1611 | ME |
NPI | 1235228073 |
---|---|
Provider Name | Teresa A Caprio |
First Address | Kennebunkport, ME 04046-5823 |
Second Address | Kennebunk, ME 04043-7159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G97163 | (02) | ME |