Provider Demographics
NPI:1720183007
Name:JUDE, MARY E (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:JUDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 UNION ST., STE 5
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0000
Mailing Address - Country:US
Mailing Address - Phone:207-945-5247
Mailing Address - Fax:207-992-2154
Practice Address - Street 1:1048 UNION ST., STE 5
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-0000
Practice Address - Country:US
Practice Address - Phone:207-945-5247
Practice Address - Fax:207-992-2154
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily