Healthcare Provider Details

I. General information

NPI: 1346031192
Provider Name (Legal Business Name): HOPE OUELLETTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 UNION ST STE 15
BANGOR ME
04401-3083
US

IV. Provider business mailing address

885 UNION ST STE 15
BANGOR ME
04401-3083
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-9595
  • Fax:
Mailing address:
  • Phone: 207-973-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3046
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: