Individual
CHARITY MANIATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPH, MPH, PAC
Contact information
Practice address
66 BRAMHALL ST, PORTLAND, ME 04102-3344
(207) 662-3157
Mailing address
66 BRAMHALL ST, PORTLAND, ME 04102-3344
(207) 662-3157
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1360
ME
Other
Enumeration date
09/28/2012
Last updated
09/30/2014
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