Healthcare Provider Details

I. General information

NPI: 1952213977
Provider Name (Legal Business Name): JULIE ANNE PELLETIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 STATE ST STE 121
BANGOR ME
04401-6630
US

IV. Provider business mailing address

417 STATE ST STE 121
BANGOR ME
04401-6630
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-4266
  • Fax:
Mailing address:
  • Phone: 207-973-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN51110
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: