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General NPI Number Information
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NPI Number | 1043108053
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Entity Type | Individual
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Provider Name | CORA LEE GAVETT PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 93 CAMPUS AVE
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City | LEWISTON
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State | ME
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Zip | 04240-6030
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Country | US
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Telephone | 207-777-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 1231 MAIN ST
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City | SUMNER
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State | ME
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Zip | 04292-3003
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Country | US
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Telephone | 207-577-5077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP251246
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License Number State | ME
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