Individual
KIMBERLEY R FANTASIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
200 KENNEDY MEMORIAL DR, WATERVILLE, ME 04901-4526
(207) 681-3000
Mailing address
200 KENNEDY MEMORIAL DR, WATERVILLE, ME 04901-4526
(207) 681-3000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP081842
ME
363LF0000X
Family Nurse Practitioner
R051730
ME
Other
Enumeration date
04/17/2007
Last updated
09/02/2010
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