Provider Demographics
NPI:1083620314
Name:CIANCHETTE, EMILY B (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:B
Last Name:CIANCHETTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-4928
Mailing Address - Country:US
Mailing Address - Phone:207-487-5154
Mailing Address - Fax:207-487-3158
Practice Address - Street 1:470 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967-4928
Practice Address - Country:US
Practice Address - Phone:207-487-5154
Practice Address - Fax:207-487-3158
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER035826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME122340100Medicaid
ME261250099Medicaid