Basic Information
| Provider Information | |||||||||
| NPI: | 1629046693 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUNTRESS | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 CHURCH HILL RD | ||||||||
| Address2: | STE 1 | ||||||||
| City: | LEEDS | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042633418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075243501 | ||||||||
| FaxNumber: | 2075242459 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TURNER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042824138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075243501 | ||||||||
| FaxNumber: | 2075242459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD15562 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 247920099 | 05 | ME | MEDICAID |