Provider Demographics
NPI:1174633630
Name:MAURER, KATE YARROW (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:YARROW
Last Name:MAURER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PENOBSCOT VALLEY PRIMARY CARE
Mailing Address - Street 2:252 ENFIELD ROAD
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457
Mailing Address - Country:US
Mailing Address - Phone:207-794-3296
Mailing Address - Fax:207-794-8908
Practice Address - Street 1:PENOBSCOT VALLEY PRIMARY CARE
Practice Address - Street 2:252 ENFIELD ROAD
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457
Practice Address - Country:US
Practice Address - Phone:207-794-3296
Practice Address - Fax:207-794-8908
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004717363A00000X
MEPA1469363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME135270000Medicaid
Q29716Medicare UPIN
WA8411415Medicaid
8850203Medicare ID - Type UnspecifiedRAINIERPARK CLINIC
8850205Medicare ID - Type UnspecifiedRANIER BEACH CLINIC
8850201Medicare ID - Type Unspecified45TH ST CLINIC
8850202Medicare ID - Type UnspecifiedGREENWOOD CLINIC