Individual
SALLY J SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
10 WAYMAN LN, BAR HARBOR, ME 04609-1625
(207) 288-5081
Mailing address
10 WAYMAN LN, BAR HARBOR, ME 04609-1625
(207) 288-5082
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R044705
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280800099
—
ME
01
—
VX1201
MEDICARE - MDIH
ME
Enumeration date
07/06/2006
Last updated
06/03/2009
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