Provider Demographics
NPI:1306856745
Name:TRUSLOW, KATHLEEN (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:TRUSLOW
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 1:29 WEYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MORRILL
Mailing Address - State:ME
Mailing Address - Zip Code:04952-5007
Mailing Address - Country:US
Mailing Address - Phone:207-229-5541
Mailing Address - Fax:
Practice Address - Street 1:29 WEYMOUTH RD
Practice Address - Street 2:
Practice Address - City:MORRILL
Practice Address - State:ME
Practice Address - Zip Code:04952-5007
Practice Address - Country:US
Practice Address - Phone:207-878-0094
Practice Address - Fax:207-878-0096
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERO40324363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME079207OtherANTHEM BLUE BEHAVIORAL HE
ME100057OtherANTHEM BLUE CROSS
ME253580000Medicaid
ME253580000Medicaid
NP1853Medicare ID - Type Unspecified