Individual
IVY A G TODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNPC
Contact information
Practice address
6 TELCOM DR, BANGOR, ME 04401-3072
(207) 947-0147
(207) 990-3365
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 404-8200
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
CNP211246
ME
Other
Enumeration date
10/26/2020
Last updated
07/01/2021
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