Individual
VANCE WORMWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-7046
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-7046
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R019157
ME
Other
Enumeration date
06/10/2006
Last updated
11/26/2014
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