Provider Demographics
NPI:1083725998
Name:HANNAFORD, MARY M (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:HANNAFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:77 S HIRAM RD
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:ME
Mailing Address - Zip Code:04041-3669
Mailing Address - Country:US
Mailing Address - Phone:207-625-7786
Mailing Address - Fax:
Practice Address - Street 1:655 MAIN ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1543
Practice Address - Country:US
Practice Address - Phone:207-294-3100
Practice Address - Fax:207-286-3709
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME47248363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health