Provider Demographics
NPI:1720146616
Name:TRAQUAIR, REBECCA S (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:TRAQUAIR
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 1:185 TOWNSEND AVE
Mailing Address - Street 2:STE R
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04538-1894
Mailing Address - Country:US
Mailing Address - Phone:207-633-1075
Mailing Address - Fax:207-633-1067
Practice Address - Street 1:185 TOWNSEND AVE
Practice Address - Street 2:STE R
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-1894
Practice Address - Country:US
Practice Address - Phone:207-633-1075
Practice Address - Fax:207-633-1067
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME263330099Medicaid
ME263330099Medicaid