Provider Demographics
NPI:1275145393
Name:INCANNELLA, ELIZABETH MAE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MAE
Last Name:INCANNELLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PALMER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1341
Mailing Address - Country:US
Mailing Address - Phone:207-454-9516
Mailing Address - Fax:
Practice Address - Street 1:37 PALMER ST STE 2
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1341
Practice Address - Country:US
Practice Address - Phone:207-454-9516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily