Doctor Name: | ELLEN N. DAGGETT-MEDRANO |
NPI Number: | 1083738736 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA-428 |
Business Practice Address: | 149 Main St Ste 2a Winthrop, ME - 043641486 |
Business Phone Number: | 2076243800 |
Business Fax Number: | 2076243845 |
Mailing Address: | 149 Main St, Ste 2a WINTHROP |
State: | ME |
Postal Code: | 043641486 |
Phone Number: | 2076243800 |
Fax Number: | 2076243845 |
NPI Enumeration Date: | 03/19/2007 |
NPI Last Update Date: | 04/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA-428 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |