Provider Demographics
NPI:1922266535
Name:DAMON, ARLENE CIRCE (NP)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:CIRCE
Last Name:DAMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:BETH
Other - Last Name:O'ROURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0911
Mailing Address - Country:US
Mailing Address - Phone:207-303-3200
Mailing Address - Fax:207-250-2140
Practice Address - Street 1:100 CAMPUS DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04073
Practice Address - Country:US
Practice Address - Phone:207-303-3300
Practice Address - Fax:207-250-2139
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081079363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME248200099Medicaid
ME248200099Medicaid