1619203270 NPI number — MRS. CARRISSA BETH HANKINS FNP-C

Table of content: MRS. CARRISSA BETH HANKINS FNP-C (NPI 1619203270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619203270 NPI number — MRS. CARRISSA BETH HANKINS FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANKINS
Provider First Name:
CARRISSA
Provider Middle Name:
BETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMPBELL
Provider Other First Name:
CARRISSA
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619203270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 HIGH ST.
Provider Second Line Business Mailing Address:
STE. 300
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-795-5978
Provider Business Mailing Address Fax Number:
207-795-5645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 HIGH ST.
Provider Second Line Business Practice Location Address:
STE. 300
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-795-5978
Provider Business Practice Location Address Fax Number:
207-795-5645
Provider Enumeration Date:
11/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  CNP91062 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: AP091062 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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