Individual
MIRANDA NICELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
108 CENTRE ST STE 200, BATH, ME 04530-2550
(207) 386-1800
Mailing address
PO BOX 620, WEST FARMINGTON, ME 04992-0620
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP241405
ME
Other
Enumeration date
11/11/2024
Last updated
11/11/2024
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