Healthcare Provider Details

I. General information

NPI: 1194078329
Provider Name (Legal Business Name): MARY CATHERINE CARPENTER MSN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GLEN COVE DR STE 1
ROCKPORT ME
04856-4232
US

IV. Provider business mailing address

3 GLEN COVE DR STE 1
ROCKPORT ME
04856-4232
US

V. Phone/Fax

Practice location:
  • Phone: 207-301-8900
  • Fax: 207-301-5296
Mailing address:
  • Phone: 207-301-8900
  • Fax: 207-301-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN2282312
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN2282312
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM122005
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: