Healthcare Provider Details

I. General information

NPI: 1639736358
Provider Name (Legal Business Name): TASHA M LARY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHAMBERLAIN DR
NEWPORT ME
04953-4139
US

IV. Provider business mailing address

1 CHAMBERLAIN DR
NEWPORT ME
04953-4139
US

V. Phone/Fax

Practice location:
  • Phone: 207-431-8128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP221367
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN58005
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: