Provider Demographics
NPI:1215474580
Name:DRAKE, MONIQUE A (PA-C)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:A
Last Name:DRAKE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MONIQUE
Other - Middle Name:ANDREA
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 LIVEWELL DR
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6762
Mailing Address - Country:US
Mailing Address - Phone:207-467-8550
Mailing Address - Fax:207-467-8551
Practice Address - Street 1:2 LIVEWELL DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6762
Practice Address - Country:US
Practice Address - Phone:207-467-8550
Practice Address - Fax:207-467-8551
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH06842255A2300X
FLPAT9114205363A00000X
MEPA2807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer