Provider Demographics
NPI:1689621872
Name:BEAULAC, MARGARET (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:
Last Name:BEAULAC
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:MAINE COAST MEMORIAL HOSPITAL
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1586
Mailing Address - Country:US
Mailing Address - Phone:207-664-5304
Mailing Address - Fax:207-664-5305
Practice Address - Street 1:45 HERRICK RD
Practice Address - Street 2:SOUTHWEST HARBOR MEDICAL CENTER
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679-4433
Practice Address - Country:US
Practice Address - Phone:207-244-5513
Practice Address - Fax:207-244-5515
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP174702Medicare PIN
MENP174701Medicare PIN
MENP1747Medicare PIN
MES77589Medicare UPIN