Provider Demographics
NPI:1922625730
Name:GANTZ, ACADIA KATHRYN (CPM)
Entity Type:Individual
Prefix:
First Name:ACADIA
Middle Name:KATHRYN
Last Name:GANTZ
Suffix:
Gender:F
Credentials:CPM
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 1332
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:ME
Mailing Address - Zip Code:04055-1332
Mailing Address - Country:US
Mailing Address - Phone:435-232-8043
Mailing Address - Fax:
Practice Address - Street 1:626 LAKE HOUSE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:ME
Practice Address - Zip Code:04055-3218
Practice Address - Country:US
Practice Address - Phone:435-232-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECPM681176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife