Provider Demographics
NPI:1548309792
Name:MCINNIS, STEVEN JON
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JON
Last Name:MCINNIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SMITHS LN
Mailing Address - Street 2:
Mailing Address - City:HOLLIS CENTER
Mailing Address - State:ME
Mailing Address - Zip Code:04042-4029
Mailing Address - Country:US
Mailing Address - Phone:207-929-3264
Mailing Address - Fax:
Practice Address - Street 1:14 SMITHS LN
Practice Address - Street 2:
Practice Address - City:HOLLIS CENTER
Practice Address - State:ME
Practice Address - Zip Code:04042-4029
Practice Address - Country:US
Practice Address - Phone:207-929-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide