Healthcare Provider Details

I. General information

NPI: 1396544722
Provider Name (Legal Business Name): MEAGHAN CATHERINE SMITH REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

85 LOWER FLYING POINT RD
FREEPORT ME
04032-6305
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-2911
  • Fax:
Mailing address:
  • Phone: 207-831-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN72614
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: