Provider Demographics
NPI:1043945579
Name:VINTILA, ILEANA IRINA (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:IRINA
Last Name:VINTILA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 EDINBURG RD
Mailing Address - Street 2:
Mailing Address - City:ARGYLE TWP
Mailing Address - State:ME
Mailing Address - Zip Code:04468-7302
Mailing Address - Country:US
Mailing Address - Phone:301-542-6791
Mailing Address - Fax:
Practice Address - Street 1:268 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3945
Practice Address - Country:US
Practice Address - Phone:800-640-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2022001494363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty