Individual
MRS. NICOLE SHAWNTAY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
300 MAIN ST, LEWISTON, ME 04240-7041
(207) 795-0111
Mailing address
18 LAURIER ST, LEWISTON, ME 04240-4106
(207) 332-0522
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP211493
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F09210797
AANP
ME
Enumeration date
10/10/2021
Last updated
10/10/2021
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