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NPI Code Detail

MEDICARE: JONATHAN BEAL FNP-C

MEDICARE: JONATHAN BEAL FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerCNP211160ME

General Provider Information

NPI Number : 1518699966
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN BEAL FNP-C
Provider Business Mailing Address
First Line : 61 MAIN ST
Second Line :
City : WINDHAM
State : ME
Zip : 04062-4292
Country : US
Telephone Number : 207-577-4846
Fax Number :
Provider Business Practice Location Address
First Line : 410 ROOSEVELT TRL
Second Line :
City : NAPLES
State : ME
Zip : 04055-5329
Country : US
Telephone Number : 207-693-6106
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2022
Last Update Date : 09/08/2023

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Directions to “ JONATHAN BEAL FNP-C” Practice Location

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