Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | CNP81875 | ME |
NPI | 1013950153 |
---|---|
Provider Name | Leah Victoria Mahoney |
First Address | Scarborough, ME 04074-9701 |
Second Address | Portland, ME 04102-3344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 11/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30349017 | (05) | NH |
Q66392 | (02) | ME |