| Doctor Name: | KIMBERLEY R FANTASIA |
| NPI Number: | 1154547479 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | R051730 |
| Business Practice Address: | 200 Kennedy Memorial Dr Waterville, ME - 049014526 |
| Business Phone Number: | 2076813000 |
| Business Fax Number: | |
| Mailing Address: | 200 Kennedy Memorial Dr, WATERVILLE |
| State: | ME |
| Postal Code: | 049014526 |
| Phone Number: | 2076813000 |
| Fax Number: | |
| NPI Enumeration Date: | 04/17/2007 |
| NPI Last Update Date: | 09/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R051730 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |