Individual
MARY SHEA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
86 DAVIS ST, BANGOR, ME 04401-6410
(207) 992-2205
(207) 992-2207
Mailing address
1795 HAMMOND ST, HERMON, ME 04401-1135
(207) 992-2205
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R031280
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5871218
AETNA
ME
01
—
MN5123
HARVARD PILGRIM
ME
01
—
R031280
TRICARE
ME
Enumeration date
04/13/2006
Last updated
07/08/2007
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