Provider Demographics
NPI:1578648242
Name:CYR, PATRICIA A (RN MS ANPC FNPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:CYR
Suffix:
Gender:F
Credentials:RN MS ANPC FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2150
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2764
Mailing Address - Country:US
Mailing Address - Phone:207-373-6155
Mailing Address - Fax:207-373-6475
Practice Address - Street 1:81 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 2150
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2764
Practice Address - Country:US
Practice Address - Phone:207-373-6155
Practice Address - Fax:207-373-6475
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER018986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102140000Medicaid
11459564OtherCAQH
ME102140000Medicaid