Healthcare Provider Details

I. General information

NPI: 1912108267
Provider Name (Legal Business Name): DEBORAH MACCHI PITTIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 RIDGEWOOD DR
BANGOR ME
04401-2652
US

IV. Provider business mailing address

35 SUMMIT AVENUE
BANGOR ME
04401-5619
US

V. Phone/Fax

Practice location:
  • Phone: 208-942-0669
  • Fax: 207-947-3143
Mailing address:
  • Phone: 207-942-2343
  • Fax: 207-947-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 035751
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: