Individual
MRS. MADELYN TYACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11 HUNNEWELL RD, SCARBOROUGH, ME 04074-9539
(207) 289-3600
Mailing address
263 DANFORTH ST, PORTLAND, ME 04102-3705
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP191162
ME
Other
Enumeration date
08/09/2019
Last updated
08/09/2019
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