Provider Demographics
NPI:1073531422
Name:TESSMANN, ROWENA (PMH-NP, PHD)
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:
Last Name:TESSMANN
Suffix:
Gender:F
Credentials:PMH-NP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 ELM ST.
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-680-2065
Mailing Address - Fax:207-680-2068
Practice Address - Street 1:58 ELM ST.
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-680-2065
Practice Address - Fax:207-680-2068
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER038001364SP0809X, 363LP0808X
MEAP 081192363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432295299Medicaid
ME238000099Medicaid