Healthcare Provider Details

I. General information

NPI: 1710488788
Provider Name (Legal Business Name): PAULLE JEANNE RICHARD CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULLE JEANNE DARBY

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 MAIN ST
NORWAY ME
04268-5645
US

IV. Provider business mailing address

193 MAIN ST
NORWAY ME
04268-5645
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-8766
  • Fax: 207-553-8348
Mailing address:
  • Phone: 207-743-8766
  • Fax: 207-553-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP191015
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number129292
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: