Basic Information
Provider Information
NPI: 1831354943
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STELLER
FirstName: WAYNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PMH-NP
OtherOrganizationName:  
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OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O. BOX 422
Address2: ACADIA HOSPITAL CORP.
City: BANGOR
State: ME
PostalCode: 044020422
CountryCode: US
TelephoneNumber: 2079736100
FaxNumber: 2079736109
Practice Location
Address1: 268 STILLWATER AVENUE
Address2: ACADIA HOSPITAL CORP.
City: BANGOR
State: ME
PostalCode: 04401
CountryCode: US
TelephoneNumber: 2079736100
FaxNumber: 2079736109
Other Information
ProviderEnumerationDate: 07/29/2008
LastUpdateDate: 07/29/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XR031982MEY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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