Provider Demographics
NPI:1790186310
Name:PENDER, ANN MARIE M (PMHNP)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:M
Last Name:PENDER
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 1:45 PORTLAND RD, SUITE 7, BOX 295
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6660
Mailing Address - Country:US
Mailing Address - Phone:207-467-3553
Mailing Address - Fax:
Practice Address - Street 1:45 PORTLAND ROAD SUITE 7, NO. 295
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-0404
Practice Address - Country:US
Practice Address - Phone:207-467-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP141072363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001843201Medicare PIN