Provider Demographics
NPI:1043108053
Name:GAVETT, CORA LEE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:LEE
Last Name:GAVETT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:CORA
Other - Middle Name:LEE
Other - Last Name:POMERLEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1231 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:ME
Mailing Address - Zip Code:04292-3003
Mailing Address - Country:US
Mailing Address - Phone:207-577-5077
Mailing Address - Fax:
Practice Address - Street 1:93 CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6030
Practice Address - Country:US
Practice Address - Phone:207-777-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP251246363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health