Provider Demographics
NPI:1306277272
Name:POULIN, NATALIE (LMT)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
Last Name:POULIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 STATE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1173
Mailing Address - Country:US
Mailing Address - Phone:207-894-4913
Mailing Address - Fax:207-648-4512
Practice Address - Street 1:88 STATE ST STE 301
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1173
Practice Address - Country:US
Practice Address - Phone:207-894-4913
Practice Address - Fax:207-648-4512
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist