Healthcare Provider Details

I. General information

NPI: 1174633630
Provider Name (Legal Business Name): KATE YARROW MAURER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/13/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PENOBSCOT VALLEY PRIMARY CARE 252 ENFIELD ROAD
LINCOLN ME
04457
US

IV. Provider business mailing address

PENOBSCOT VALLEY PRIMARY CARE 252 ENFIELD ROAD
LINCOLN ME
04457
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-3296
  • Fax: 207-794-8908
Mailing address:
  • Phone: 207-794-3296
  • Fax: 207-794-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004717
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1469
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: