Healthcare Provider Details

I. General information

NPI: 1841281128
Provider Name (Legal Business Name): MABEL WADSWORTH WOMEN'S HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MT HOPE AVE SUITE 420
BANGOR ME
04401
US

IV. Provider business mailing address

700 MT HOPE AVE SUITE 420
BANGOR ME
04401
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-5337
  • Fax: 207-947-9163
Mailing address:
  • Phone: 207-947-5337
  • Fax: 207-947-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATE WANING
Title or Position: DIRECTOR OF FINANCE & OPERATIONS
Credential:
Phone: 207-947-5337