| Doctor Name: | CHRISTINA ROSE THERIAULT |
| NPI Number: | 1538245097 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 1538245097 |
| Business Practice Address: | 139 Market St Fort Kent, ME - 047431410 |
| Business Phone Number: | 2074023220 |
| Business Fax Number: | 2078341188 |
| Mailing Address: | Po Box 587, AUGUSTA |
| State: | ME |
| Postal Code: | 043320587 |
| Phone Number: | 2075093271 |
| Fax Number: | 2076604203 |
| NPI Enumeration Date: | 10/27/2006 |
| NPI Last Update Date: | 08/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | 1538245097 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |