Basic Information
| Provider Information | |||||||||
| NPI: | 1912013616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ST. GERMAIN | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | NP | ||||||||
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| 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: | 08/23/2006 | ||||||||
| LastUpdateDate: | 04/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | CNP81134 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363L00000X | 016448 | ME | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.