Individual
ANDREW WILLIAM FONDERLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-0111
Mailing address
52 HANOVER ST UNIT 604, PORTLAND, ME 04101-5942
(330) 469-0309
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.459526
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA243055
ME
Other
Enumeration date
04/05/2024
Last updated
08/05/2024
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