Healthcare Provider Details

I. General information

NPI: 1588623375
Provider Name (Legal Business Name): PATRICIA LYNN OUELLETTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: P LYNN OUELLETTE MD

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 RAYMOND RD
BRUNSWICK ME
04011-7359
US

IV. Provider business mailing address

80 RAYMOND RD
BRUNSWICK ME
04011-7359
US

V. Phone/Fax

Practice location:
  • Phone: 207-721-0080
  • Fax: 207-406-4791
Mailing address:
  • Phone: 207-721-0080
  • Fax: 207-406-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberMD12555
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12555
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD12555
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: