Provider Demographics
NPI:1336474774
Name:ACKERSON, CARMEN J (APRN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:J
Last Name:ACKERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7902
Mailing Address - Country:US
Mailing Address - Phone:207-624-4800
Mailing Address - Fax:207-624-4801
Practice Address - Street 1:442 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7902
Practice Address - Country:US
Practice Address - Phone:207-624-4800
Practice Address - Fax:207-624-4801
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH51878-23363L00000X
MECNP141085363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner