Provider Demographics
NPI:1114218435
Name:PHILBROOK, PATRICIA SULLIVAN (NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:SULLIVAN
Last Name:PHILBROOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 WATER ST
Mailing Address - Street 2:
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1400
Mailing Address - Country:US
Mailing Address - Phone:207-512-8633
Mailing Address - Fax:888-688-0407
Practice Address - Street 1:47 WATER ST
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1400
Practice Address - Country:US
Practice Address - Phone:207-512-8633
Practice Address - Fax:888-688-0407
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER 020625363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner