Provider Demographics
NPI:1831715796
Name:BEAULIEU, OLIVIA (FNP-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DAIGLE XRD
Mailing Address - Street 2:
Mailing Address - City:SAINT AGATHA
Mailing Address - State:ME
Mailing Address - Zip Code:04772-6008
Mailing Address - Country:US
Mailing Address - Phone:207-316-3737
Mailing Address - Fax:
Practice Address - Street 1:23 NORTH ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2291
Practice Address - Country:US
Practice Address - Phone:207-768-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily