Provider Demographics
NPI:1003885690
Name:TRUEWORTHY, MICHAEL URBAN (CNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:URBAN
Last Name:TRUEWORTHY
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BYRD AVE
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9779
Mailing Address - Country:US
Mailing Address - Phone:207-730-0964
Mailing Address - Fax:207-773-7303
Practice Address - Street 1:650 MAIN ST
Practice Address - Street 2:STE 213
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-835-6098
Practice Address - Fax:207-835-6097
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81149363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME244780099Medicaid
METRNP4799Medicare UPIN