Organization
PENOBSCOT INDIAN NATION
Active
Other names
PENOBSCOT NATION HEALTH DEPARTMNT
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA KNOX NICOLA (DIRECTOR)
(207) 817-7400
Entity
Organization
Contact information
Practice address
23 WABANAKI WAY, INDIAN ISLAND, ME 04468-1252
(207) 817-7400
(207) 817-7452
Mailing address
23 WABANAKI WAY, INDIAN ISLAND, ME 04468-1252
(207) 817-7400
(207) 817-7452
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
PH50000041
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106520200
—
ME
01
—
2036350
PK
—
Enumeration date
08/14/2006
Last updated
10/11/2016
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