Provider Demographics
NPI:1508596438
Name:VIRUET-TORRES, ADAIS JOHAN (APN)
Entity Type:Individual
Prefix:
First Name:ADAIS
Middle Name:JOHAN
Last Name:VIRUET-TORRES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CHAMBERLAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1903
Mailing Address - Country:US
Mailing Address - Phone:207-631-5106
Mailing Address - Fax:
Practice Address - Street 1:118 BENNETT DR STE 130
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2052
Practice Address - Country:US
Practice Address - Phone:207-498-3476
Practice Address - Fax:207-498-3534
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP221323363L00000X
NJ26NJ15044100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily