Basic Information
| Provider Information | |||||||||
| NPI: | 1699718346 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMUTH | ||||||||
| FirstName: | JOANN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 HOSPITAL DR | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | YORK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039091011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073512478 | ||||||||
| FaxNumber: | 2073512153 | ||||||||
| Practice Location | |||||||||
| Address1: | HARBOUR WOMEN'S HEALTH | ||||||||
| Address2: | 155 GRIFFIN ROAD | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038014125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034316011 | ||||||||
| FaxNumber: | 6034316227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 11/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 036453-23-01 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 30004919 | 05 | NH | MEDICAID | MD0033237 | 01 | DEA | OTHER | 11456703 | 01 | CAQH | OTHER |