Healthcare Provider Details

I. General information

NPI: 1689621872
Provider Name (Legal Business Name): MARGARET BEAULAC FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HERRICK RD SOUTHWEST HARBOR MEDICAL CENTER
SOUTHWEST HARBOR ME
04679-4433
US

IV. Provider business mailing address

50 UNION ST MAINE COAST MEMORIAL HOSPITAL
ELLSWORTH ME
04605-1586
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-5513
  • Fax: 207-244-5515
Mailing address:
  • Phone: 207-664-5304
  • Fax: 207-664-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP81308
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: