Healthcare Provider Details

I. General information

NPI: 1770086142
Provider Name (Legal Business Name): SHERRIE LEE PELLETIER RN, BSN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MOUNTAINVIEW DR
FORT KENT ME
04743-1614
US

IV. Provider business mailing address

3 MOUNTAINVIEW DR
FORT KENT ME
04743-1614
US

V. Phone/Fax

Practice location:
  • Phone: 207-834-3971
  • Fax: 207-834-3837
Mailing address:
  • Phone: 207-834-3971
  • Fax: 207-834-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN49609
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: