Individual
AMY G TAISEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
887 CONGRESS ST, PORTLAND, ME 04102-3100
(207) 774-6368
Mailing address
887 CONGRESS ST, PORTLAND, ME 04102-3100
(207) 774-6368
(207) 774-9388
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1214
ME
363AS0400X
Surgical Physician Assistant
PA001214
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA001214
PA LICENSE
ME
01
—
PA1214
PA LICENSE
ME
Enumeration date
06/24/2010
Last updated
03/17/2018
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