Provider Demographics
NPI:1669672176
Name:THARPE, NELL L (CNM, CRNFA)
Entity Type:Individual
Prefix:
First Name:NELL
Middle Name:L
Last Name:THARPE
Suffix:
Gender:F
Credentials:CNM, CRNFA
Other - Prefix:
Other - First Name:NELL
Other - Middle Name:L
Other - Last Name:EISELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-0587
Mailing Address - Country:US
Mailing Address - Phone:207-626-3426
Mailing Address - Fax:207-622-0836
Practice Address - Street 1:43 GABRIEL DRIVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04332-0587
Practice Address - Country:US
Practice Address - Phone:207-626-3426
Practice Address - Fax:207-622-0836
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER028377367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM3246Medicare UPIN