Provider Demographics
NPI:1265543847
Name:MCDOUGALL, LINDA L (NP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:MCDOUGALL
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 1:900 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1900
Mailing Address - Country:US
Mailing Address - Phone:207-907-1187
Mailing Address - Fax:207-907-1189
Practice Address - Street 1:900 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-1900
Practice Address - Country:US
Practice Address - Phone:207-907-1187
Practice Address - Fax:207-907-1189
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81565363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432219699Medicaid
MENP5193Medicare PIN
ME432219699Medicaid
MEP00419576Medicare PIN