Individual
THORA HOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
175 WEST BROADWAY, LINCOLN, ME 04457-0000
(207) 794-6700
(207) 794-6466
Mailing address
PO BOX 99, LINCOLN, ME 04457-0099
(207) 794-6700
(207) 794-6777
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
025743
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
035045
ANTHEM
ME
01
—
201837
NGS
ME
05
—
257420099
—
ME
Enumeration date
03/21/2006
Last updated
03/04/2013
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