C EDWARD STALEY (NPI# 1073522462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073522462 |
| Entity Type | Individual |
| Full Name | C EDWARD STALEY |
| Credential | PA |
| Practice Address |
175 W Broadway Lincoln ME 04457-4000 |
| Mailing Address |
Po Box 99 Lincoln ME 04457-0099 |
| Practice Telephone | 2077946700 |
| Practice Fax Number | 2077946777 |
| Mailing Telephone | (207) 794-6700 |
| Mailing Fax Number | 2077946777 |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2017-05-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA259 | ME | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ME | 320050099 | 05 |
| Street Address |
175 W BROADWAY |
| City | LINCOLN |
| State | ME |
| Zip Code | 04457-4000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023005378 | Dominick Olivo | Podiatrist | 175 W Broadway, Lincoln, ME 04457-4000 | 2005-10-03 |
| 1871088914 | Amber Lee Willey | Nurse Practitioner | 175 W Broadway, Lincoln, ME 04457-4000 | 2018-06-29 |
| 1235623307 | Oluwapelumi Aderonke Adeloye | Dentist | 175 W Broadway, Lincoln, ME 04457-4000 | 2018-06-21 |
| 1447780002 | Jamie Perry | Nurse Practitioner | 175 W Broadway, Lincoln, ME 04457-4000 | 2017-06-15 |
| 1023550399 | Mark Kent | Psychologist | 175 W Broadway, Lincoln, ME 04457-4000 | 2016-11-17 |
| 1942679899 | Laycee Duhaime | Nurse Practitioner | 175 W Broadway, Lincoln, ME 04457-4000 | 2015-09-22 |
| 1437533460 | Alex J Braddock | Physician Assistant | 175 W Broadway, Lincoln, ME 04457-4000 | 2015-07-20 |
| 1417399205 | Jodie L Perfect | Nurse Practitioner | 175 W Broadway, Lincoln, ME 04457-4000 | 2013-07-23 |
| 1154764975 | Katie Marie Adams | Family Medicine | 175 W Broadway, Lincoln, ME 04457 | 2013-04-11 |
| 1467895201 | Diksha Malik | Family Medicine | 175 W Broadway, Lincoln, ME 04457 | 2013-04-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467928317 | Carlos Lopez & Associates LLC | Counselor | 213 W. Broadway, Lincoln, ME 04457 | 2018-10-18 |
| 1902303142 | Jennifer Harvey | Speech-Language Pathologist | 36 Workman Terrace Street, Lincoln, ME 04457 | 2018-04-12 |
| 1255714275 | Jill Bouchard | Registered Nurse | 313 Enfield Rd, Lincoln, ME 04457 | 2015-07-08 |
| 1346594769 | Total Renal Care Inc | Clinic/Center | 250 Enfield Rd, Lincoln, ME 04457 | 2012-11-07 |
| 1932429743 | Anne Marie Osolinski | Counselor | 8 Fleming Street, Suite C, Lincoln, ME 04457 | 2010-06-03 |
| 1477886711 | Lakeview Afch Inc | Custodial Care Facility | 10 E Broadway, Lincoln, ME 04457 | 2009-09-17 |
| 1326273418 | Colonial Healthcare | Assisted Living Facility | 36 Workman Terrace, Lincoln, ME 04457 | 2009-05-19 |
| 1730346743 | Mark B Weatherbee Od | Optometrist | 26 Enfield Road, Lincoln, ME 04457 | 2008-05-19 |
| 1396948139 | Alfred H. Vandine Jr. | Counselor | 313 Enfield Road, Lincoln, ME 04457 | 2007-06-08 |
| 1902024870 | Mary Catherine Goolsby | Social Worker | 313 Enfield Rd., Lincoln, ME 04457 | 2007-04-23 |
| Find all providers in zip 04457 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619580156 | Alana M Oster | Physician Assistant | 129 Chapel St, Lincoln, RI 02865-2119 | 2020-08-25 |
| 1871143891 | Ashley Moreau | Physician Assistant | 4 Lauretta Ln, Lincoln, RI 02865-1338 | 2019-09-12 |
| 1013574862 | Erin Grace Dragoo | Physician Assistant | 2310 Wesley Dr, Lincoln, NE 68512-3704 | 2019-05-28 |
| 1629535521 | Jason Theodore | Physician Assistant | 4615 Meredeth St Apt 6, Lincoln, NE 68506-4973 | 2019-02-27 |
| 1144674276 | Austin Bryce Henslee | Physician Assistant | 575 S 70th St Ste 310, Lincoln, NE 68510 | 2016-04-14 |
| 1790163814 | Mary Elizabeth Tucker | Physician Assistant | 1500 S 48th St., Suite 800, Lincoln, NE 68506-1200 | 2015-05-08 |
| 1942542790 | Linda Denise Corr | Physician Assistant | 4451 N 26th St Ste 1000, Lincoln, NE 68521-4144 | 2013-03-20 |
| 1669734794 | Kimberly Kathryn Piening | Physician Assistant | 1101 S 70th St Ste 100, Lincoln, NE 68510-4293 | 2012-06-14 |
| 1548521933 | Terumi Degraw | Physician Assistant | 1715 S 26th St, Lincoln, NE 68502-3061 | 2012-06-02 |
| 1609103415 | Kristen Alyce Bruening | Physician Assistant | 8550 Cuthills Cir, Lincoln, NE 68526-9474 | 2009-11-16 |
| Find all providers in LINCOLN | ||||
Please comment or provide details below to improve the information on C EDWARD STALEY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.