Provider Demographics
NPI:1932193679
Name:WAITT, ANN B (PNP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:B
Last Name:WAITT
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:133 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4312
Practice Address - Country:US
Practice Address - Phone:207-941-1155
Practice Address - Fax:207-945-5063
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MER025924363LP0200X
MARN2297592363LP0200X
MEAP081657363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110104405AMedicaid
MEE05194Medicare UPIN