Healthcare Provider Details

I. General information

NPI: 1043945579
Provider Name (Legal Business Name): ILEANA IRINA VINTILA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 MAIN ST
ORONO ME
04473-4007
US

IV. Provider business mailing address

82 MAIN ST
ORONO ME
04473-4007
US

V. Phone/Fax

Practice location:
  • Phone: 207-447-7837
  • Fax: 207-358-2577
Mailing address:
  • Phone: 207-447-7837
  • Fax: 207-358-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022001494
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: