Provider Demographics
NPI:1932209426
Name:TEDESCO-SCHNECK, MARY (PNPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TEDESCO-SCHNECK
Suffix:
Gender:F
Credentials:PNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 STATE ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6623
Mailing Address - Country:US
Mailing Address - Phone:207-973-8853
Mailing Address - Fax:207-973-6966
Practice Address - Street 1:404 STATE ST
Practice Address - Street 2:SUITE 310
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6623
Practice Address - Country:US
Practice Address - Phone:207-973-8853
Practice Address - Fax:207-973-6966
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81676363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics