Individual
MARY ELSA THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
55 REYNOLDS ROAD, BROOKS, ME 04915
(207) 722-3488
(207) 722-3183
Mailing address
PO BOX 159, BROOKS, ME 04921-0159
(207) 722-3488
(207) 722-3183
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R030807
ME
Other
Enumeration date
11/30/2006
Last updated
07/08/2007
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