Provider Demographics
NPI:1841281128
Name:MABEL WADSWORTH WOMEN'S HEALTH CENTER
Entity type:Organization
Organization Name:MABEL WADSWORTH WOMEN'S HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE & OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-947-5337
Mailing Address - Street 1:700 MT HOPE AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-947-5337
Mailing Address - Fax:207-947-9163
Practice Address - Street 1:700 MT HOPE AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-947-5337
Practice Address - Fax:207-947-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME165020000Medicaid