Basic Information
| Provider Information | |||||||||
| NPI: | 1083007306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPECTRE | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | HEWITT | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 226 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049150226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073221807 | ||||||||
| FaxNumber: | 2073386820 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 NORTHPORT AVE | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049156009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079302639 | ||||||||
| FaxNumber: | 2073388368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2015 | ||||||||
| LastUpdateDate: | 03/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | CNP151010 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.