Provider Demographics
NPI:1578642849
Name:LENIHAN, JUDITH (RN-C)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:LENIHAN
Suffix:
Gender:F
Credentials:RN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:ME
Mailing Address - Zip Code:04929-3213
Mailing Address - Country:US
Mailing Address - Phone:207-873-2136
Mailing Address - Fax:207-872-4522
Practice Address - Street 1:67 EUSTIS PKWY
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5173
Practice Address - Country:US
Practice Address - Phone:207-873-2136
Practice Address - Fax:207-872-4522
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER036078163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0232606-03OtherANCC
MER036078OtherRN-C LICENSE
ME339580099Medicaid