Provider Demographics
NPI:1194225292
Name:PRO-ELDER CONSULTING LLC
Entity Type:Organization
Organization Name:PRO-ELDER CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:207-944-2523
Mailing Address - Street 1:7 HIGHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5739
Mailing Address - Country:US
Mailing Address - Phone:207-873-0705
Mailing Address - Fax:855-738-7685
Practice Address - Street 1:7 HIGHWOOD ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5739
Practice Address - Country:US
Practice Address - Phone:207-873-0705
Practice Address - Fax:855-738-7685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP101030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty