Healthcare Provider Details

I. General information

NPI: 1841225109
Provider Name (Legal Business Name): MARY E. GAMACHE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS DR STE 125
SCARBOROUGH ME
04074
US

IV. Provider business mailing address

190 RIVERSIDE ST UNIT 6B
PORTLAND ME
04103-1073
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-0069
  • Fax: 207-883-0999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number166814
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCNP181069
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: