Provider Demographics
NPI:1962890509
Name:DUMOND, MARY (RN, LMT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DUMOND
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3822
Mailing Address - Country:US
Mailing Address - Phone:207-232-8965
Mailing Address - Fax:
Practice Address - Street 1:535 OCEAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4970
Practice Address - Country:US
Practice Address - Phone:207-232-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN34708163WM1400X
MEMT994163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)