Provider Demographics
NPI:1619084076
Name:LIBERATORE, JOANNA CATES (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:CATES
Last Name:LIBERATORE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:MARIE
Other - Last Name:CATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:191 S MAIN ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2307
Mailing Address - Country:US
Mailing Address - Phone:207-659-8428
Mailing Address - Fax:207-407-7231
Practice Address - Street 1:191 S MAIN ST UNIT 6
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2307
Practice Address - Country:US
Practice Address - Phone:207-461-5909
Practice Address - Fax:207-407-7231
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER 043562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AANP CERTIFICATE NO.OtherF0604005