Individual
GINNY CROCKETT-MAILLET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
195 FORE RIVER PKWY, SUITE 360, PORTLAND, ME 04102-2780
(207) 553-6868
Mailing address
GENERAL DELIVERY, WISCASSET, ME 04578-9999
(970) 420-1640
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
081878
ME
Other
Enumeration date
11/20/2014
Last updated
11/20/2014
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