Provider Demographics
NPI:1477502227
Name:MCMAHAN, IRENE S (NP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:S
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2250 MILLARD HARRISON DR
Mailing Address - Street 2:MARANACOOK COMMUNITY SCHOOL STUDENT HEALTH CENTER
Mailing Address - City:READFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04355
Mailing Address - Country:US
Mailing Address - Phone:207-685-4923
Mailing Address - Fax:207-685-9597
Practice Address - Street 1:2250 MILLARD HARRISON DR
Practice Address - Street 2:MARANACOOK COMMUNITY SCHOOL STUDENT HEALTH CENTER
Practice Address - City:READFIELD
Practice Address - State:ME
Practice Address - Zip Code:04355
Practice Address - Country:US
Practice Address - Phone:207-685-4923
Practice Address - Fax:207-685-9597
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MER016171363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME416800099Medicaid