1770076044 NPI number — MRS. SHELLEY MARIE VOGEL

Table of content: MRS. SHELLEY MARIE VOGEL (NPI 1770076044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770076044 NPI number — MRS. SHELLEY MARIE VOGEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOGEL
Provider First Name:
SHELLEY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STILLSON
Provider Other First Name:
SHELLEY
Provider Other Middle Name:
MARIE
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:
1770076044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 SAUNDERS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04236-4104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-713-9918
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 TUCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03842-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-431-2530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2018

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: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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