Provider Demographics
NPI:1639735715
Name:KATHLEEN DISHNER, INC
Entity Type:Organization
Organization Name:KATHLEEN DISHNER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DISHNER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:207-504-7631
Mailing Address - Street 1:62 BAYVIEW ST UNIT 23
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-2252
Mailing Address - Country:US
Mailing Address - Phone:207-706-4163
Mailing Address - Fax:207-706-4173
Practice Address - Street 1:62 BAYVIEW ST UNIT 23
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-2252
Practice Address - Country:US
Practice Address - Phone:207-706-4163
Practice Address - Fax:207-706-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MER019254OtherLICENSE