Basic Information
| Provider Information | |||||||||
| NPI: | 1902026628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMMACK | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RNC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | HAMPDEN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044441034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074707459 | ||||||||
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| Practice Location | |||||||||
| Address1: | 42 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079470366 | ||||||||
| FaxNumber: | 2079903927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 163WP0808X | R039791 | ME | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.