Individual provider Active NPI

Ann B. Waitt, PNP

  • Pediatric Nurse Practitioner
  • Bangor, ME
National Provider Identifier
1932193679
Registry record updated May 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
AP081657 Issued in ME
Practice address
133 Corporate Dr
Bangor, ME 04401-4312
Phone
(207) 941-1155
Fax
(207) 945-5063
NPI assigned
Sep 8, 2005
Last updated
May 28, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X R025924 ME
Pediatric Nurse Practitioner 363LP0200X RN2297592 MA
Pediatric Nurse Practitioner 363LP0200X AP081657 ME Primary

Addresses

Primary practice location

133 Corporate Dr
Bangor, ME 04401-4312

Mailing address

43 Whiting Hill Rd Ste 300
Brewer, ME 04412-1006
Phone (207) 973-5035

Other identifiers 1

IdentifierTypeStateIssuer
110104405AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090804000587 ME Practitioner - Nurse Practitioner 5991858284 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN2297592MAMDPediatric Nurse Practitioner
AP081657MEMDPediatric Nurse Practitioner
R025924MEMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
York Hospital CurrentSince May 21, 2018 Accepting new patients
Eastern Maine Medical Center CurrentSince May 24, 2020 Accepting new patients
Eastern Maine Medical Center CurrentSince May 24, 2020 Accepting new patients

Locations

133 Corporate Dr
Bangor, ME 04401
Phone (207) 941-1155

489 State St
Bangor, ME 04401
Phone (207) 973-8837

43 Whiting Hill Rd
Ste 300
Brewer, ME 04412
Phone (207) 973-5000

15 Hospital Dr
York, ME 03909
Phone (207) 351-2478

16 Hospital Dr
Ste D
York, ME 03909
Phone (207) 351-1710

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590624000000",
    "number": "1932193679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 WHITING HILL RD STE 300",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044121006",
            "telephone_number": "207-973-5035",
            "fax_number": "207-973-5042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 CORPORATE DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014312",
            "telephone_number": "207-941-1155",
            "fax_number": "207-945-5063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAITT",
        "first_name": "ANN",
        "middle_name": "B.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-08",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "ME",
            "license": "R025924",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "RN2297592",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "ME",
            "license": "AP081657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110104405A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.