Provider Demographics
NPI:1306880729
Name:NEALLEY, CHRISTINE A (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:NEALLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TWOMBLY RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:ME
Mailing Address - Zip Code:04951-3225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:329 WILSON ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1504
Practice Address - Country:US
Practice Address - Phone:207-307-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431539999Medicaid
ME4961926001OtherCIGNA
ME030175OtherANTHEM GROUP
ME144828OtherAETNA GROUP
ME030175OtherANTHEM GROUP
MEQ35057Medicare UPIN