MEDICARE: MARY DUNLAP N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	022631	ME
2	363LF0000X	Family Nurse Practitioner	APO81024	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164494662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY DUNLAP N.P.

Provider Business Mailing Address
First Line	:	111 FRANKLIN HEALTH CMNS
Second Line	:
City	:	FARMINGTON
State	:	ME
Zip	:	04938-6144
Country	:	US
Telephone Number	:	207-897-6601
Fax Number	:	207-897-4339

Provider Business Practice Location Address
First Line	:	38 UNION ST
Second Line	:
City	:	LIVERMORE FALLS
State	:	ME
Zip	:	04254-1229
Country	:	US
Telephone Number	:	207-897-6601
Fax Number	:	207-897-4339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	11/22/2011

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