Healthcare Provider Details

I. General information

NPI: 1013230515
Provider Name (Legal Business Name): MARY S RAFTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 WATER ST
WISCASSET ME
04578-4133
US

IV. Provider business mailing address

PO BOX 351
WISCASSET ME
04578-4133
US

V. Phone/Fax

Practice location:
  • Phone: 207-882-6008
  • Fax: 207-882-7803
Mailing address:
  • Phone: 207-882-6008
  • Fax: 207-882-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR057032
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP111050
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: