Individual
CANDICE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
225 GORHAM RD STE 200, SOUTH PORTLAND, ME 04106-2462
(800) 757-3326
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-3500
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
074678-21
NH
163W00000X
Registered Nurse
2310377
MA
363L00000X
Nurse Practitioner
074678-23
NH
363LP2300X
Primary Care Nurse Practitioner
Primary
CNP231278
ME
363LP2300X
Primary Care Nurse Practitioner
RN2310377
MA
Other
Enumeration date
04/06/2017
Last updated
05/05/2025
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