Provider Demographics
NPI:1982248506
Name:PERHAM, NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PERHAM
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:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-0962
Mailing Address - Country:US
Mailing Address - Phone:207-590-1407
Mailing Address - Fax:
Practice Address - Street 1:24 HUNTERS LN
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:ME
Practice Address - Zip Code:04002-7365
Practice Address - Country:US
Practice Address - Phone:207-590-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN51564163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty