Healthcare Provider Details

I. General information

NPI: 1154161925
Provider Name (Legal Business Name): LEANN HEWEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 OLD POINT AVE
MADISON ME
04950-1114
US

IV. Provider business mailing address

37 OAK ST
WATERVILLE ME
04901-5524
US

V. Phone/Fax

Practice location:
  • Phone: 207-696-4681
  • Fax:
Mailing address:
  • Phone: 210-852-9238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH4382
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: