Healthcare Provider Details

I. General information

NPI: 1609794130
Provider Name (Legal Business Name): LAURA CHARLOTTE CLINTON CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 PROSPECT ST
PORTLAND ME
04103-3038
US

IV. Provider business mailing address

199 PROSPECT ST
PORTLAND ME
04103-3038
US

V. Phone/Fax

Practice location:
  • Phone: 518-779-1577
  • Fax: --
Mailing address:
  • Phone: 518-779-1577
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM892
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: