Healthcare Provider Details

I. General information

NPI: 1770665986
Provider Name (Legal Business Name): PAMALA SUE PELLON-IRWIN FNP APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 S PATTEN RD
PATTEN ME
04765-3007
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 866-366-5842
  • Fax:
Mailing address:
  • Phone: 207-992-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP81229
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR043787
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: