Healthcare Provider Details

I. General information

NPI: 1417434804
Provider Name (Legal Business Name): SARAH PATRICIA PELLETIER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BOLDUC AVE
FORT KENT ME
04743-1602
US

IV. Provider business mailing address

12 BOLDUC AVE
FORT KENT ME
04743-1602
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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP181192
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: