Provider Demographics
NPI:1578951406
Name:PERKINS, WENDOLYN ANN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:WENDOLYN
Middle Name:ANN
Last Name:PERKINS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-275-3800
Mailing Address - Fax:207-275-3836
Practice Address - Street 1:1 NORTHEAST DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4332
Practice Address - Country:US
Practice Address - Phone:207-275-3800
Practice Address - Fax:207-275-3836
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP141116363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010211501Medicaid
ME010211501Medicare PIN
ME010211501Medicare UPIN
ME010211501Medicaid