Provider Demographics
NPI:1053179788
Name:ALL STAR FOOT CARE
Entity type:Organization
Organization Name:ALL STAR FOOT CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GAULIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:207-478-3132
Mailing Address - Street 1:143 EAMES RD
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-0541
Mailing Address - Country:US
Mailing Address - Phone:207-478-3132
Mailing Address - Fax:
Practice Address - Street 1:179 MAIN ST STE 214
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6672
Practice Address - Country:US
Practice Address - Phone:207-405-2510
Practice Address - Fax:207-481-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1241240001Medicaid