Healthcare Provider Details

I. General information

NPI: 1912455809
Provider Name (Legal Business Name): CORTNEY MULDOON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 ROOSEVELT TRL
NAPLES ME
04055-5329
US

IV. Provider business mailing address

410 ROOSEVELT TRL
NAPLES ME
04055-5329
US

V. Phone/Fax

Practice location:
  • Phone: 207-693-6106
  • Fax: 207-693-4026
Mailing address:
  • Phone: 207-693-6106
  • Fax: 207-693-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP161119
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: