Provider Demographics
NPI:1013608645
Name:SCICHILONE, MERYL JONES (FNP-C)
Entity type:Individual
Prefix:
First Name:MERYL
Middle Name:JONES
Last Name:SCICHILONE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FORE RIVER PKWY STE 410
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2788
Mailing Address - Country:US
Mailing Address - Phone:207-774-9839
Mailing Address - Fax:
Practice Address - Street 1:195 FORE RIVER PKWY STE 410
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2788
Practice Address - Country:US
Practice Address - Phone:207-774-9839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily