Provider Demographics
NPI:1679799365
Name:WITHERELL, NANCY ANN
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ANN
Last Name:WITHERELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SANDYS WAY
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ME
Mailing Address - Zip Code:04258-5021
Mailing Address - Country:US
Mailing Address - Phone:207-345-3371
Mailing Address - Fax:
Practice Address - Street 1:22 SANDYS WAY
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ME
Practice Address - Zip Code:04258-5021
Practice Address - Country:US
Practice Address - Phone:207-345-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home