Individual
STACEY LEA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8 S MAIN ST, MADISON, ME 04950-4501
(207) 696-3992
Mailing address
PO BOX 727, WATERVILLE, ME 04903-0727
(207) 696-3992
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
MD22365
ME
208D00000X
General Practice Physician
Primary
MD22365
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710990775
—
ME
Enumeration date
08/14/2006
Last updated
05/02/2024
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