Basic Information
| Provider Information | |||||||||
| NPI: | 1801863006 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TULLY | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CARMICHAEL | ||||||||
| OtherFirstName: | LINDA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8 SOUTH MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076963992 | ||||||||
| FaxNumber: | 2076963974 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 SOUTH MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076963992 | ||||||||
| FaxNumber: | 2076963974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 03/30/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R026453 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 313490099 | 05 | ME | MEDICAID |