Provider Demographics
NPI:1104201011
Name:VILLMORE, DANA L (PA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:VILLMORE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:100 GANNETT DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-828-0361
Mailing Address - Fax:207-874-1483
Practice Address - Street 1:INTERMED ONSITE AT IDEXX
Practice Address - Street 2:1 IDEXX DRIVE
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092
Practice Address - Country:US
Practice Address - Phone:207-556-6802
Practice Address - Fax:207-556-4434
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2019-12-18
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Provider Licenses
StateLicense IDTaxonomies
MEPA1554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant