Healthcare Provider Details

I. General information

NPI: 1639382435
Provider Name (Legal Business Name): NEW ENGLAND WOMEN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 WESTERN AVENUE
SOUTH PORTLAND ME
04106
US

IV. Provider business mailing address

260 WESTERN AVENUE
SOUTH PORTLAND ME
04106
US

V. Phone/Fax

Practice location:
  • Phone: 207-761-4700
  • Fax: 207-761-4744
Mailing address:
  • Phone: 207-761-4700
  • Fax: 207-761-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR027192
License Number StateME

VIII. Authorized Official

Name: SUSAN DAVIS DOUGHTY
Title or Position: OWNER
Credential: NP
Phone: 207-761-4700