Provider Demographics
NPI:1689664831
Name:CARROLL, NANCY APEL (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:APEL
Last Name:CARROLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6143
Mailing Address - Country:US
Mailing Address - Phone:207-761-0650
Mailing Address - Fax:207-761-8198
Practice Address - Street 1:778 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5447
Practice Address - Country:US
Practice Address - Phone:207-775-1255
Practice Address - Fax:207-775-1299
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081710363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30346876Medicaid
ME297340099Medicaid
ME297340099Medicaid
NH30346876Medicaid
MENP178401Medicare PIN