Provider Demographics
NPI:1568988137
Name:PETROPOULOS, MARIA THERESA CARDONA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA THERESA
Middle Name:CARDONA
Last Name:PETROPOULOS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HEATHER LOCH
Mailing Address - Street 2:
Mailing Address - City:NORTH YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04097-6431
Mailing Address - Country:US
Mailing Address - Phone:207-415-6739
Mailing Address - Fax:
Practice Address - Street 1:19 S GORHAM XING
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-2690
Practice Address - Country:US
Practice Address - Phone:207-535-1400
Practice Address - Fax:207-535-1439
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily