Healthcare Provider Details

I. General information

NPI: 1053246876
Provider Name (Legal Business Name): LAUREN WEBSTER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AIRPORT RD
WATERVILLE ME
04901-4524
US

IV. Provider business mailing address

40 AIRPORT RD
WATERVILLE ME
04901-4524
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-7272
  • Fax:
Mailing address:
  • Phone: 207-872-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN78118
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: