Individual
MARTHA WEDDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMH-NP
Contact information
Practice address
263 STATE ST STE 23, BANGOR, ME 04401-5438
(207) 945-3615
(207) 945-3444
Mailing address
263 STATE ST STE 23, BANGOR, ME 04401-5438
(207) 945-3615
(207) 945-3444
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R024076
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100028
ANTHEM
ME
Enumeration date
12/11/2006
Last updated
07/08/2007
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