Provider Demographics
NPI:1881933950
Name:CREEDON, PAUL THOMAS (FNP-C)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:THOMAS
Last Name:CREEDON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 US ROUTE 1 STE J
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7168
Mailing Address - Country:US
Mailing Address - Phone:207-396-6433
Mailing Address - Fax:207-396-6436
Practice Address - Street 1:71 US ROUTE 1 STE J
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7168
Practice Address - Country:US
Practice Address - Phone:207-396-6433
Practice Address - Fax:207-396-6436
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP131006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily