Healthcare Provider Details

I. General information

NPI: 1669722013
Provider Name (Legal Business Name): LEEANNE S MATHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEEANNE SCHOENFELD APRN

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MARGINAL WAY
PORTLAND ME
04101-2438
US

IV. Provider business mailing address

161 MARGINAL WAY
PORTLAND ME
04101-2438
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-7964
  • Fax:
Mailing address:
  • Phone: 207-773-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP251652
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number064302-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: