Provider Demographics
NPI:1689135162
Name:FEAGA, LAURA RUTH (PMHNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RUTH
Last Name:FEAGA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 SEBEC LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:ME
Mailing Address - Zip Code:04443-4345
Mailing Address - Country:US
Mailing Address - Phone:207-659-5160
Mailing Address - Fax:
Practice Address - Street 1:8 MOOSEHEAD LN APT 111
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1402
Practice Address - Country:US
Practice Address - Phone:207-659-5160
Practice Address - Fax:888-346-9284
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191197363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health