Healthcare Provider Details

I. General information

NPI: 1952636318
Provider Name (Legal Business Name): ELIZABETH GAUDETTE RN, LCCE, CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 3RD AVE
YORK ME
03909-6838
US

IV. Provider business mailing address

11 3RD AVE
YORK ME
03909-6838
US

V. Phone/Fax

Practice location:
  • Phone: 207-363-1379
  • Fax:
Mailing address:
  • Phone: 207-363-1379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberR049622
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number114354
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: