Provider Demographics
NPI:1659505451
Name:MAINE CDC PUBLIC HEALTH NURSING
Entity Type:Organization
Organization Name:MAINE CDC PUBLIC HEALTH NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH NURSING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:R
Authorized Official - Last Name:LITTLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:207-287-9025
Mailing Address - Street 1:286 WATER ST KEY PLZ FL 7
Mailing Address - Street 2:STATE HOUSE STATION # 11
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04333-0011
Mailing Address - Country:US
Mailing Address - Phone:207-287-9025
Mailing Address - Fax:207-287-5355
Practice Address - Street 1:286 WATER ST KEY PLZ FL 7
Practice Address - Street 2:STATE HOUSE STATION # 11
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-0011
Practice Address - Country:US
Practice Address - Phone:207-287-9025
Practice Address - Fax:207-287-5355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MAINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-07
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME135910300OtherBILLING PROVIDER NUMBER