Provider Demographics
NPI:1619518719
Name:FACENDOLA, WARREN (NP)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:FACENDOLA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7676
Mailing Address - Country:US
Mailing Address - Phone:207-795-5700
Mailing Address - Fax:
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7676
Practice Address - Country:US
Practice Address - Phone:207-795-5700
Practice Address - Fax:207-795-5727
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP221177363LA2200X
MARN2287373363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health