Basic Information
| Provider Information | |||||||||
| NPI: | 1851700371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PROSSER | ||||||||
| FirstName: | SHEELAGH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047693243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077692025 | ||||||||
| FaxNumber: | 2077640629 | ||||||||
| Practice Location | |||||||||
| Address1: | 66 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047693243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077692025 | ||||||||
| FaxNumber: | 2077640629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2014 | ||||||||
| LastUpdateDate: | 02/20/2015 | ||||||||
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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 | 207Q00000X | MD14454 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.