Healthcare Provider Details

I. General information

NPI: 1790834588
Provider Name (Legal Business Name): COLETTE MARIE BEAUMONT RNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLETTE BEAUMONT KAUFMAN

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 US ROUTE 1 # 1
SCARBOROUGH ME
04074
US

IV. Provider business mailing address

180 US ROUTE 1 # 1
SCARBOROUGH ME
04074-9073
US

V. Phone/Fax

Practice location:
  • Phone: 207-289-3640
  • Fax:
Mailing address:
  • Phone: 207-289-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP10996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: