Provider Demographics
NPI:1457840084
Name:CASE, MARY E (PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CASE
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5059
Mailing Address - Country:US
Mailing Address - Phone:207-307-2287
Mailing Address - Fax:207-573-0641
Practice Address - Street 1:104 CENTER ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5059
Practice Address - Country:US
Practice Address - Phone:207-307-2287
Practice Address - Fax:207-573-0641
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181148363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily