Healthcare Provider Details

I. General information

NPI: 1770920100
Provider Name (Legal Business Name): DANIELLE M PELLETIER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 NORTHPORT AVE
BELFAST ME
04915-6009
US

IV. Provider business mailing address

118 NORTHPORT AVE
BELFAST ME
04915-6009
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-9345
  • Fax:
Mailing address:
  • Phone: 207-338-9345
  • Fax: 207-338-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM172001
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: