Provider Demographics
NPI:1053419846
Name:BARTLETT, CYNTHIA I (NP-C)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:I
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:I
Other - Last Name:BEAULIEU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CONGRESS ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2129
Mailing Address - Country:US
Mailing Address - Phone:207-773-7964
Mailing Address - Fax:207-874-1492
Practice Address - Street 1:1200 CONGRESS ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2129
Practice Address - Country:US
Practice Address - Phone:207-773-7964
Practice Address - Fax:207-874-1492
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME032826363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q64476Medicare UPIN
MENP5283Medicare ID - Type Unspecified