Healthcare Provider Details

I. General information

NPI: 1386636603
Provider Name (Legal Business Name): TERESA NEPRUD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA BRADBERRY STANFILL CRNP

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W BROADWAY
LINCOLN ME
04457-4000
US

IV. Provider business mailing address

411 WALNUT ST # 13588
GREEN COVE SPRINGS FL
32043-3443
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-6700
  • Fax:
Mailing address:
  • Phone: 410-353-7961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60856983
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201909625NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR200127
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP231210
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: