Individual
THERESA KAVANAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
66 STONE ST, AUGUSTA, ME 04330-5227
(207) 626-3455
Mailing address
66 STONE ST, AUGUSTA, ME 04330-5227
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN61760
ME
Other
Enumeration date
01/19/2016
Last updated
01/19/2016
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