Healthcare Provider Details

I. General information

NPI: 1932209426
Provider Name (Legal Business Name): MARY TEDESCO-SCHNECK PNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 STATE ST SUITE 310
BANGOR ME
04401-6623
US

IV. Provider business mailing address

404 STATE ST SUITE 310
BANGOR ME
04401-6623
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-8853
  • Fax: 207-973-6966
Mailing address:
  • Phone: 207-973-8853
  • Fax: 207-973-6966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP81676
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: