Provider Demographics
NPI:1346282233
Name:COOLEY, NANCY JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:COOLEY
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 1:13 RAILROAD SQ
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6139
Mailing Address - Country:US
Mailing Address - Phone:207-872-6869
Mailing Address - Fax:207-872-7910
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-877-3400
Practice Address - Fax:207-877-3401
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP5354Medicare PIN
MEQ69903Medicare UPIN
MENP535401Medicare PIN