=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164730685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH ANN LABONTE NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2010
-----------------------------------------------------
Last Update Date | 08/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 BISHOP ST 2ND FLOOR
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04103-2659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-879-6160
-----------------------------------------------------
Fax | 207-871-5668
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 WASHINGTON AVE STE 100
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04103-2842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-871-1200
-----------------------------------------------------
Fax | 207-871-1232
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP101060
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------