Basic Information
| Provider Information | |||||||||
| NPI: | 1114449915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARDWELL | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MORANG | ||||||||
| OtherFirstName: | KATHRYN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 569 | ||||||||
| Address2: | |||||||||
| City: | RANGELEY | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049700569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078642699 | ||||||||
| FaxNumber: | 2078642969 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 ENTERPRISE DR | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043307997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076218880 | ||||||||
| FaxNumber: | 2076211881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2017 | ||||||||
| LastUpdateDate: | 05/01/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CNP171079 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.