Provider Demographics
NPI:1336111988
Name:PUTNAM, NANCY Y (FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:Y
Last Name:PUTNAM
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 1:22 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1844
Mailing Address - Country:US
Mailing Address - Phone:207-532-3289
Mailing Address - Fax:207-532-6071
Practice Address - Street 1:22 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1844
Practice Address - Country:US
Practice Address - Phone:207-532-3289
Practice Address - Fax:207-532-6071
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP2496Medicare PIN
P09613Medicare UPIN