Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | CNP81149 | ME |
NPI | 1003885690 |
---|---|
Provider Name | Mr. Michael Urban Trueworthy |
First Address | Scarborough, ME 04074-9779 |
Second Address | South Portland, ME 04106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 05/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TRNP4799 | (02) | ME |