Healthcare Provider Details

I. General information

NPI: 1619084076
Provider Name (Legal Business Name): JOANNA CATES LIBERATORE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNA MARIE CATES FNP-C

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S MAIN ST UNIT 6
BREWER ME
04412-2307
US

IV. Provider business mailing address

191 S MAIN ST UNIT 6
BREWER ME
04412-2307
US

V. Phone/Fax

Practice location:
  • Phone: 207-461-5909
  • Fax: 207-407-7231
Mailing address:
  • Phone: 207-659-8428
  • Fax: 207-407-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 043562
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: