Healthcare Provider Details

I. General information

NPI: 1316353733
Provider Name (Legal Business Name): MOLLY BROWN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 MARGINAL WAY STE 1000
PORTLAND ME
04101-2477
US

IV. Provider business mailing address

300 SOUTHBOROUGH DR STE 120
SOUTH PORTLAND ME
04106-6978
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-4092
  • Fax:
Mailing address:
  • Phone: 207-347-2947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2283233
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP151165
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: