Provider Demographics
NPI:1730200973
Name:MARTIN, DAIL MARIE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:DAIL
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:ME
Mailing Address - Zip Code:04015-4143
Mailing Address - Country:US
Mailing Address - Phone:207-743-7399
Mailing Address - Fax:207-743-1589
Practice Address - Street 1:29 WINTER ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5618
Practice Address - Country:US
Practice Address - Phone:207-743-7399
Practice Address - Fax:207-743-1589
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER016030363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0010325Medicare PIN
ME001032701Medicare UPIN