Healthcare Provider Details

I. General information

NPI: 1447276886
Provider Name (Legal Business Name): DIANNE JEAN RAYMOND PMH-NP, DSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANNE JEAN PELLETIER

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CLEMENT WAY
BELGRADE ME
04917-4370
US

IV. Provider business mailing address

PO BOX 569
RANGELEY ME
04970-0569
US

V. Phone/Fax

Practice location:
  • Phone: 207-495-3323
  • Fax: 207-495-3353
Mailing address:
  • Phone: 207-864-2699
  • Fax: 207-864-2969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR025851
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberAP081135
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: