Provider Demographics
NPI:1164653879
Name:FAGONE, RENEE S (NP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:S
Last Name:FAGONE
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7676
Mailing Address - Country:US
Mailing Address - Phone:207-795-5700
Mailing Address - Fax:207-795-5727
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7676
Practice Address - Country:US
Practice Address - Phone:207-795-5700
Practice Address - Fax:207-795-5727
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2017-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MECNP91032363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health