Individual
MARK ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
180 PARK AVE, PORTLAND, ME 04102-2957
(207) 874-2141
Mailing address
180 PARK AVE, PORTLAND, ME 04102-2957
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN84251
ME
Other
Enumeration date
10/17/2023
Last updated
10/17/2023
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