Healthcare Provider Details

I. General information

NPI: 1811606692
Provider Name (Legal Business Name): GRACE MERRIFIELD PEASE CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RIVER RD
LIMINGTON ME
04049-3709
US

IV. Provider business mailing address

20 FARM LN
CORNISH ME
04020-3270
US

V. Phone/Fax

Practice location:
  • Phone: 207-329-2111
  • Fax:
Mailing address:
  • Phone: 207-205-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM772
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: