Healthcare Provider Details

I. General information

NPI: 1518699966
Provider Name (Legal Business Name): JONATHAN BEAL FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 ROOSEVELT TRL
NAPLES ME
04055-5329
US

IV. Provider business mailing address

61 MAIN ST
WINDHAM ME
04062-4292
US

V. Phone/Fax

Practice location:
  • Phone: 207-693-6106
  • Fax:
Mailing address:
  • Phone: 207-577-4846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP211160
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: