Individual
ELIZABETH DERHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
934 CONGRESS ST, PORTLAND, ME 04102-3032
(207) 874-2141
Mailing address
180 PARK AVE, PORTLAND, ME 04102-2957
(207) 874-2141
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN12298
ME
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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