Healthcare Provider Details

I. General information

NPI: 1437733987
Provider Name (Legal Business Name): ANNA NATHALIE ALTHAUS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 MAIN ST
YARMOUTH ME
04096-4703
US

IV. Provider business mailing address

100 GANNETT DR STE C
SOUTH PORTLAND ME
04106-5900
US

V. Phone/Fax

Practice location:
  • Phone: 207-846-9013
  • Fax: 207-523-8586
Mailing address:
  • Phone: 207-828-0361
  • Fax: 207-874-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2208
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: