Healthcare Provider Details

I. General information

NPI: 1083870620
Provider Name (Legal Business Name): HEATHER GEORGIANNA BEVERIDGE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
LEWISTON ME
04240-7027
US

IV. Provider business mailing address

300 MAIN ST
LEWISTON ME
04240-7027
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-0111
  • Fax: 207-795-2766
Mailing address:
  • Phone: 207-795-0111
  • Fax: 207-795-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP141049
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM122004
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP141049
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: