Individual
MATTHEW BRUCE PREDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-2526
Mailing address
1302 BROADWAY, SOUTH PORTLAND, ME 04106-4135
(262) 325-0810
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA173010
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306373790
—
ME
Enumeration date
05/16/2017
Last updated
08/06/2020
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