Provider Demographics
NPI:1376220616
Name:COOVER, MADDREY ALICIA (FNP)
Entity Type:Individual
Prefix:
First Name:MADDREY
Middle Name:ALICIA
Last Name:COOVER
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 1:185 SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:STEUBEN
Mailing Address - State:ME
Mailing Address - Zip Code:04680-2715
Mailing Address - Country:US
Mailing Address - Phone:207-598-6250
Mailing Address - Fax:
Practice Address - Street 1:16 COMMUNITY LN
Practice Address - Street 2:
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679-4273
Practice Address - Country:US
Practice Address - Phone:207-244-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily