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General NPI Number Information
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NPI Number | 1346352978
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Entity Type | Individual
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Provider Name | MARYANN W WATERMAN FNP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 887 CONGRESS ST SUITE 320
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City | SCARBOROUGH
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State | ME
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Zip | 04102-3103
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Country | US
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Telephone | 207-662-5522
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Fax | 207-662-5527
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Provider Business Mailing Address
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Address Line | 301 US ROUTE 1 BUILDING C
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9701
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP081559
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License Number State | ME
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