Healthcare Provider Details

I. General information

NPI: 1528474186
Provider Name (Legal Business Name): HANA JOYCE PELLETIER APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 MAIN STREET SUITE 1
NORWAY ME
04268
US

IV. Provider business mailing address

PO BOX 63
BRYANT POND ME
04219-0063
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-7721
  • Fax: 207-743-6306
Mailing address:
  • Phone: 207-743-7721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP141076
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: