Provider Demographics
NPI:1881818409
Name:CAULEY, NELLIE DAS (ANP)
Entity Type:Individual
Prefix:
First Name:NELLIE
Middle Name:DAS
Last Name:CAULEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5801
Mailing Address - Country:US
Mailing Address - Phone:207-783-1449
Mailing Address - Fax:207-777-3865
Practice Address - Street 1:710 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5801
Practice Address - Country:US
Practice Address - Phone:207-783-1449
Practice Address - Fax:207-777-3865
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005932363LA2200X
MECNP201512363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006394Medicaid
NCNC9460AMedicare PIN
TX8D9369Medicare PIN
TXQ51248Medicare UPIN
TX8D9218Medicare PIN
TX206321601Medicaid
TX206321602Medicaid