Healthcare Provider Details

I. General information

NPI: 1184555260
Provider Name (Legal Business Name): MOSAIC INTEGRATIVE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MONUMENT PL
TOPSHAM ME
04086-1253
US

IV. Provider business mailing address

150 SPRING DR
BOWDOIN ME
04287-7052
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-7101
  • Fax: 720-915-4083
Mailing address:
  • Phone: 207-200-7101
  • Fax: 720-915-4083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: PENNY WORTMAN
Title or Position: OWNER
Credential: DNP, CNM
Phone: 207-751-0074