Provider Demographics
NPI:1245267335
Name:BOOMER, ANN (NNP)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:BOOMER
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
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Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5000
Mailing Address - Fax:207-973-5163
Practice Address - Street 1:NICU PROFESSIONAL SERVICES EMMC
Practice Address - Street 2:489 STATE STREET
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-0404
Practice Address - Country:US
Practice Address - Phone:207-973-8670
Practice Address - Fax:207-973-5163
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MER0480862080N0001X
MECNP816202080N0001X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES53924Medicare UPIN
MENP4827Medicare ID - Type Unspecified