Provider Demographics
NPI:1366115701
Name:MCCOURT ALBERT, SALLIE ALICIA (APRN, FNP)
Entity type:Individual
Prefix:
First Name:SALLIE
Middle Name:ALICIA
Last Name:MCCOURT ALBERT
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HARPSWELL RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2549
Mailing Address - Country:US
Mailing Address - Phone:207-523-9158
Mailing Address - Fax:
Practice Address - Street 1:51 HARPSWELL RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2549
Practice Address - Country:US
Practice Address - Phone:207-523-9158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP2111368363LP0808X
MECNP211368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health