Individual
NICHOLAS D PENNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1321 WASHINGTON AVE, 301, PORTLAND, ME 04103-3636
(207) 780-6565
(207) 878-6565
Mailing address
1321 WASHINGTON AVE, 301, PORTLAND, ME 04103-3636
(207) 780-6565
(207) 878-6565
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R049269
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30347108
—
NH
05
—
433046299
—
ME
Enumeration date
05/27/2006
Last updated
07/25/2013
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