Provider Demographics
NPI:1134121114
Name:BILODEAU, DONNA (FNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BILODEAU
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 1:13 RAILROAD SQ
Mailing Address - Street 2:KENNEBEC FAMILY PRACTICE
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6139
Mailing Address - Country:US
Mailing Address - Phone:207-872-6869
Mailing Address - Fax:207-872-7910
Practice Address - Street 1:13 RAILROAD SQ
Practice Address - Street 2:KENNEBEC FAMILY PRACTICE
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6139
Practice Address - Country:US
Practice Address - Phone:207-872-6869
Practice Address - Fax:207-872-7910
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME245620099Medicaid
ME245620099Medicaid
MENP152101Medicare PIN
MES70149Medicare UPIN