Provider Demographics
NPI:1790834588
Name:BEAUMONT, COLETTE MARIE (RNNP)
Entity Type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:MARIE
Last Name:BEAUMONT
Suffix:
Gender:F
Credentials:RNNP
Other - Prefix:
Other - First Name:COLETTE
Other - Middle Name:BEAUMONT
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:180 US ROUTE 1 # 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9073
Mailing Address - Country:US
Mailing Address - Phone:207-289-3640
Mailing Address - Fax:
Practice Address - Street 1:180 US ROUTE 1 # 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-289-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20728ZMedicare ID - Type Unspecified
CAZZZ201482Medicare UPIN