Provider Demographics
NPI:1619151628
Name:LAW-HAM, DANA MERRILL (FNP-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MERRILL
Last Name:LAW-HAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MERRILL
Other - Last Name:LAW-HINDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:174 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5134
Mailing Address - Country:US
Mailing Address - Phone:207-861-3002
Mailing Address - Fax:207-861-3281
Practice Address - Street 1:180 KENNEDY MEMORIAL DR STE 304
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4548
Practice Address - Country:US
Practice Address - Phone:207-873-1036
Practice Address - Fax:207-873-1039
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432864599Medicaid
ME432864599Medicaid
S28733Medicare UPIN