Healthcare Provider Details

I. General information

NPI: 1003099961
Provider Name (Legal Business Name): PEGGY A OUELLETTE FPMH-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 BATH RD
BRUNSWICK ME
04011-2609
US

IV. Provider business mailing address

12 PINEBROOK LN
PORTLAND ME
04102-1313
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR039058
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: