Individual
MR. SHAWN THEBERGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN, FNP-C, NR-P
Contact information
Practice address
200 W SUMMIT AVE, WALES, WI 53183-9427
(207) 650-7540
Mailing address
11 CANYON WAY, WINDHAM, ME 04062-4895
(207) 650-7540
Taxonomy
Speciality
Code
Description
License number
State
146L00000X
Paramedic
P8036707
ME
163W00000X
Registered Nurse
RN72498
ME
363LF0000X
Family Nurse Practitioner
Primary
CNP201467
ME
Other
Enumeration date
08/12/2020
Last updated
08/03/2021
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