Provider Demographics
NPI:1255458196
Name:STAFFORD, EMILIE WOLF (RN, MS, CRNP)
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:WOLF
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:RN, MS, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5000
Mailing Address - Fax:207-973-8812
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6674
Practice Address - Country:US
Practice Address - Phone:207-275-1082
Practice Address - Fax:207-275-8812
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC005337363LN0005X
MECNP221186363LN0005X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care