Provider Demographics
NPI:1598428476
Name:WESTERN MOUNTAIN NEUROSOLUTIONS
Entity Type:Organization
Organization Name:WESTERN MOUNTAIN NEUROSOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:207-491-9151
Mailing Address - Street 1:145 MAIN ST # 1
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-1924
Mailing Address - Country:US
Mailing Address - Phone:207-779-6553
Mailing Address - Fax:207-652-2445
Practice Address - Street 1:145 MAIN ST # 1
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-1924
Practice Address - Country:US
Practice Address - Phone:207-779-6553
Practice Address - Fax:207-652-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1992241236Medicaid
MECNP161223OtherMAINE STATE BOARD OF NURSING