Healthcare Provider Details

I. General information

NPI: 1285364489
Provider Name (Legal Business Name): KAYLEE SHAE PUANANI WOLFE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ENTERPRISE DR
AUGUSTA ME
04330-7894
US

IV. Provider business mailing address

10 WATER ST STE 202
WATERVILLE ME
04901-6565
US

V. Phone/Fax

Practice location:
  • Phone: 207-248-0460
  • Fax: 207-248-0461
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP221268
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: