Provider Demographics
NPI:1265477905
Name:CLEWS, HENRIETTA T (CNM)
Entity Type:Individual
Prefix:MS
First Name:HENRIETTA
Middle Name:T
Last Name:CLEWS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-0179
Mailing Address - Country:US
Mailing Address - Phone:207-374-2473
Mailing Address - Fax:866-667-9612
Practice Address - Street 1:250 EAST BLUE HILL ROAD
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614
Practice Address - Country:US
Practice Address - Phone:207-374-2473
Practice Address - Fax:866-667-9612
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER022802367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102380200Medicaid
ME102380306Medicaid
ME292460099Medicaid
ME102380100Medicaid
ME102380301Medicaid
ME102380100Medicaid
MECLME1884Medicare PIN
ME102380301Medicaid
ME102380200Medicaid
ME20Z300Medicare PIN
ME200051Medicare PIN