Provider Demographics
NPI:1023064953
Name:DALFONSO, FRANCINE (FNP)
Entity type:Individual
Prefix:
First Name:FRANCINE
Middle Name:
Last Name:DALFONSO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MEDICAL CENTER DR
Mailing Address - Street 2:2350
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2764
Mailing Address - Country:US
Mailing Address - Phone:207-373-6690
Mailing Address - Fax:207-373-6695
Practice Address - Street 1:81 MEDICAL CENTER DR
Practice Address - Street 2:2350
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2764
Practice Address - Country:US
Practice Address - Phone:207-373-6690
Practice Address - Fax:207-373-6695
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433046499Medicaid
11459566OtherCAQH
11459566OtherCAQH
ME433046499Medicaid
P64491Medicare UPIN