| NPI | 1174897078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA JAUREGUI Director Provider Enrollment & Cvo 207-661-5414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical |
| 363LA2100X Nurse Practitioner Acute Care | |
| 363LA2200X Nurse Practitioner Adult Health | |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2022-12-13 |