1396114427 NPI number — MIKEE SPAULDING FNP-C

Table of content: MIKEE SPAULDING FNP-C (NPI 1396114427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396114427 NPI number — MIKEE SPAULDING FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPAULDING
Provider First Name:
MIKEE
Provider Middle Name:
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396114427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329 MAINE ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04011-3310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-319-1847
Provider Business Mailing Address Fax Number:
207-319-1897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
329 MAINE ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04011-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-319-1847
Provider Business Practice Location Address Fax Number:
207-319-1897
Provider Enumeration Date:
09/18/2015

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:  CNP151112 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CNP151112 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: AA453328 . This is a "HARVARD PILGRIM ID" identifier . This identifiers is of the category "OTHER".




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