Healthcare Provider Details

I. General information

NPI: 1831715796
Provider Name (Legal Business Name): OLIVIA BEAULIEU FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 NORTH ST
PRESQUE ISLE ME
04769-2291
US

IV. Provider business mailing address

40 DAIGLE XRD
SAINT AGATHA ME
04772-6008
US

V. Phone/Fax

Practice location:
  • Phone: 207-768-4000
  • Fax:
Mailing address:
  • Phone: 207-316-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP201211
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: