Provider Demographics
NPI:1386280170
Name:STOLIKER, AMELIA
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:STOLIKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1576
Mailing Address - Country:US
Mailing Address - Phone:207-834-3481
Mailing Address - Fax:
Practice Address - Street 1:108 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1576
Practice Address - Country:US
Practice Address - Phone:207-834-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2687390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program