Provider Demographics
NPI:1801832969
Name:COLE, JOHN M (RN, FNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:COLE
Suffix:
Gender:M
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:CASTINE
Mailing Address - State:ME
Mailing Address - Zip Code:04421-0198
Mailing Address - Country:US
Mailing Address - Phone:207-326-4348
Mailing Address - Fax:207-326-4340
Practice Address - Street 1:102 COURT STREET
Practice Address - Street 2:
Practice Address - City:CASTINE
Practice Address - State:ME
Practice Address - Zip Code:04421
Practice Address - Country:US
Practice Address - Phone:207-326-4348
Practice Address - Fax:207-326-4340
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER023607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME270840099Medicaid
MENP2693Medicare ID - Type UnspecifiedMEDICARE - PERS
ME270840099Medicaid
MENP269302Medicare PIN
MENP269301Medicare PIN