Provider Demographics
NPI:1184653545
Name:PELLETIER, DENYSE M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DENYSE
Middle Name:M
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7676
Mailing Address - Country:US
Mailing Address - Phone:207-795-5700
Mailing Address - Fax:207-795-5727
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:STE 400
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7676
Practice Address - Country:US
Practice Address - Phone:207-795-5700
Practice Address - Fax:207-795-5727
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081787363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MER026816OtherMAINE LICENSE
U0278ZMedicare ID - Type Unspecified
MER026816OtherMAINE LICENSE