Provider Demographics
NPI:1558142000
Name:RACINE, HEATHER DENISE (FNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DENISE
Last Name:RACINE
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 1:37 PINKHAM RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429-6208
Mailing Address - Country:US
Mailing Address - Phone:207-299-3766
Mailing Address - Fax:
Practice Address - Street 1:302 HUSSON AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3374
Practice Address - Country:US
Practice Address - Phone:207-941-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily