Provider Demographics
NPI:1104786151
Name:LIGHTHOUSE DIABETES CENTER
Entity type:Organization
Organization Name:LIGHTHOUSE DIABETES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:631-664-2112
Mailing Address - Street 1:26 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1361
Mailing Address - Country:US
Mailing Address - Phone:207-814-8718
Mailing Address - Fax:
Practice Address - Street 1:26 MALLARD DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1361
Practice Address - Country:US
Practice Address - Phone:207-814-8718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty