Provider Demographics
NPI:1053780312
Name:SCALA, ELISE (NP)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:SCALA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:SCALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:655 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072
Mailing Address - Country:US
Mailing Address - Phone:207-602-3571
Mailing Address - Fax:207-602-3573
Practice Address - Street 1:655 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3251
Practice Address - Country:US
Practice Address - Phone:207-602-3571
Practice Address - Fax:207-602-3573
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP151040363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology