Provider Demographics
NPI:1093855207
Name:LARRABEE, SALLY L (RN)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:L
Last Name:LARRABEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 BANGOR RD
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426
Mailing Address - Country:US
Mailing Address - Phone:207-564-2464
Mailing Address - Fax:207-564-2404
Practice Address - Street 1:572 BANGOR RD
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426
Practice Address - Country:US
Practice Address - Phone:207-564-2464
Practice Address - Fax:207-564-2404
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERO22264163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME294800099Medicare ID - Type UnspecifiedRN