Basic Information
| Provider Information | |||||||||
| NPI: | 1447303961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIN | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | ELENA | ||||||||
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| Credential: | FNP-BC, APRN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 PUNKIN VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | BRIDGTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040093425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075958756 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | LIBERTY BAY RECOVERY CENTER | ||||||||
| Address2: | 343 FOREST AVENUE | ||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077729800 | ||||||||
| FaxNumber: | 2075361511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 02/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CNP191234 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.