| Mary Elsa Theobald, NP | |
|
55 Reynolds Road, Brooks, ME 04915 | |
| (207) 722-3488 | |
| (207) 722-3183 |
| Full Name | Mary Elsa Theobald |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner |
| Location | 55 Reynolds Road, Brooks, Maine |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356418685 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363L00000X | Nurse Practitioner | R030807 (Maine) | Primary |
| Entity Name | Waldo County General Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1841397932 PECOS PAC ID: 2163332883 Enrollment ID: O20040428001058 |
| Entity Name | Mainehealth |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1790265502 PECOS PAC ID: 7517860588 Enrollment ID: O20040701000166 |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Elsa Theobald, NP Po Box 159, Brooks, ME 04921-0159 Ph: (207) 722-3488 | Mary Elsa Theobald, NP 55 Reynolds Road, Brooks, ME 04915 Ph: (207) 722-3488 |
Julia Ann Mushrall, FNP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 55 Reynolds Rd, Brooks, ME 04921 Phone: 207-722-3488 | |
Ronald E. Cormier, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 55 Reynolds Road, Brooks, ME 04921 Phone: 207-722-3488 Fax: 207-722-3183 |