Healthcare Provider Details

I. General information

NPI: 1770827503
Provider Name (Legal Business Name): MARTHA ELIZABETH BROWN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date: 06/07/2022
Reactivation Date: 07/08/2022

III. Provider practice location address

25 DEPOT ST
KINGFIELD ME
04947-4208
US

IV. Provider business mailing address

25 DEPOT ST
KINGFIELD ME
04947-4208
US

V. Phone/Fax

Practice location:
  • Phone: 207-265-4555
  • Fax: 207-264-5004
Mailing address:
  • Phone: 207-265-4555
  • Fax: 207-264-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP171018
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP1514222
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704305289
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1461
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02420
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8534
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: