Healthcare Provider Details

I. General information

NPI: 1558788489
Provider Name (Legal Business Name): RENEE MARIE PINETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 12/08/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HIGH STREET
LEWISTON ME
04240-7027
US

IV. Provider business mailing address

17 HIGH STREET
LEWISTON ME
04240
US

V. Phone/Fax

Practice location:
  • Phone: 207-344-2921
  • Fax:
Mailing address:
  • Phone: 207-795-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD046254
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD046254
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: