Provider Demographics
NPI:1780674937
Name:HACKETT, LINDA ATHERTON (CNM)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ATHERTON
Last Name:HACKETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CAMPUS DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7133
Mailing Address - Country:US
Mailing Address - Phone:207-885-8400
Mailing Address - Fax:207-885-8498
Practice Address - Street 1:96 CAMPUS DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7133
Practice Address - Country:US
Practice Address - Phone:207-885-8400
Practice Address - Fax:207-885-8498
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER013083367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES04554Medicare UPIN
MEHAMM7735Medicare ID - Type Unspecified