Provider Demographics
NPI:1518699966
Name:BEAL, JONATHAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BEAL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4292
Mailing Address - Country:US
Mailing Address - Phone:207-577-4846
Mailing Address - Fax:
Practice Address - Street 1:410 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:ME
Practice Address - Zip Code:04055-5329
Practice Address - Country:US
Practice Address - Phone:207-693-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-25
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP211160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily