Provider Demographics
NPI:1306944038
Name:GOVE-VLAHOS, SHIRLEY A (NP)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:A
Last Name:GOVE-VLAHOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD STE 34
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-9767
Mailing Address - Fax:
Practice Address - Street 1:NORTHERN LIGHT RHEUMATOLOGY 43 WHITING HILL RD, ST. 34
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412
Practice Address - Country:US
Practice Address - Phone:207-973-9767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181188363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1306944038Medicaid
MAQ61329Medicare UPIN
MANP5257Medicare ID - Type Unspecified