Provider Demographics
NPI:1437432507
Name:HERRICK, ANNE W (ANP)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:W
Last Name:HERRICK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:K
Other - Last Name:WILKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:49 SPRING STREET
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-883-1414
Practice Address - Fax:207-883-1518
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER056938163W00000X
MEAP111090363L00000X
MECNP111090363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner