Individual
KRISTINA CHADWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
300 MAIN ST, LEWISTON, ME 04240-7027
(207) 795-0111
(207) 795-7133
Mailing address
300 MAIN ST, LEWISTON, ME 04240-7027
(207) 795-0111
(207) 795-7133
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA631
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010416156
CIGNA / GREAT WEST
—
01
—
025716
ANTHEM
—
01
—
0378600001
DMERC
—
01
—
100294000
USPS WC
—
01
—
1044480
AETNA
—
01
—
201017
MEDICARE ASC FACILITY
—
05
—
261500099
—
ME
01
—
970026374
RR MEDICARE
—
01
—
AP1070
PTAN
—
01
—
MM0716
MEDICARE CLINIC FACILITY
—
Enumeration date
10/25/2005
Last updated
09/11/2009
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