Provider Demographics
NPI:1467428805
Name:DEXTER, CYNTHIA KANE (NP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KANE
Last Name:DEXTER
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 1:22 BRAMHALL STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-4051
Mailing Address - Country:US
Mailing Address - Phone:207-662-5588
Mailing Address - Fax:207-662-6219
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:OB/GYN CLINIC
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME029921363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP435101Medicare PIN
MEQ31142Medicare UPIN
MANP4351Medicare PIN