Healthcare Provider Details

I. General information

NPI: 1922192871
Provider Name (Legal Business Name): MARY SLOAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WELLS ST.
NORTH BERWICK ME
03906-5533
US

IV. Provider business mailing address

15 HOSPITAL DR YORK HOSPITAL
YORK ME
03909-1011
US

V. Phone/Fax

Practice location:
  • Phone: 207-676-1280
  • Fax: 207-676-1284
Mailing address:
  • Phone: 207-641-8110
  • Fax: 207-641-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR032080
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: