Provider Demographics
NPI:1265622989
Name:SULLIVAN ROHRBACH, CECILE MARTEL (FNP-C)
Entity type:Individual
Prefix:MS
First Name:CECILE
Middle Name:MARTEL
Last Name:SULLIVAN ROHRBACH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CECILE
Other - Middle Name:M
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:60 FOREST FALLS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6971
Mailing Address - Country:US
Mailing Address - Phone:207-846-0716
Mailing Address - Fax:207-846-0718
Practice Address - Street 1:60 FOREST FALLS DR STE 1
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6971
Practice Address - Country:US
Practice Address - Phone:207-846-0716
Practice Address - Fax:207-846-0718
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432658199Medicaid
ME000203701Medicare PIN