Provider Demographics
NPI:1114532371
Name:NEWMAN, MARY BETH LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:LOUISE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 S LUBEC RD
Mailing Address - Street 2:
Mailing Address - City:LUBEC
Mailing Address - State:ME
Mailing Address - Zip Code:04652-3620
Mailing Address - Country:US
Mailing Address - Phone:207-733-5541
Mailing Address - Fax:207-733-2127
Practice Address - Street 1:893 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04630-4051
Practice Address - Country:US
Practice Address - Phone:207-255-0102
Practice Address - Fax:207-255-4645
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201261363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner