Provider Demographics
NPI:1366743262
Name:MSAD 40
Entity type:Organization
Organization Name:MSAD 40
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:COCHRAN
Authorized Official - Last Name:GAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:207-832-5566
Mailing Address - Street 1:320 MANKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-5816
Mailing Address - Country:US
Mailing Address - Phone:207-832-5566
Mailing Address - Fax:207-832-5566
Practice Address - Street 1:320 MANKTOWN RD
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-5816
Practice Address - Country:US
Practice Address - Phone:207-832-5566
Practice Address - Fax:207-832-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER036504251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care