Basic Information
| Provider Information | |||||||||
| NPI: | 1730200973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | DAIL | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 174 PINE HILL RD | ||||||||
| Address2: | |||||||||
| City: | CASCO | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040154143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077437399 | ||||||||
| FaxNumber: | 2077431589 | ||||||||
| Practice Location | |||||||||
| Address1: | 29 WINTER ST | ||||||||
| Address2: | |||||||||
| City: | NORWAY | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042685618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077437399 | ||||||||
| FaxNumber: | 2077431589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 05/13/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0106X | R016030 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health |
No ID Information.