Healthcare Provider Details

I. General information

NPI: 1386712156
Provider Name (Legal Business Name): DELORES LEAVITT WETTER APRN, BC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 POTTLE RD
OXFORD ME
04270-3362
US

IV. Provider business mailing address

201 STOCK FARM RD
SOUTH PARIS ME
04281-6121
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-7911
  • Fax: 207-743-7913
Mailing address:
  • Phone: 201-743-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRO15491
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC983
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: