Provider Demographics
NPI:1477920080
Name:PELLETIER, LYNNE MARIE (RN-BSN)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:ME
Mailing Address - Zip Code:04739-0309
Mailing Address - Country:US
Mailing Address - Phone:207-444-5973
Mailing Address - Fax:207-444-5520
Practice Address - Street 1:3 MOUNTAINVIEW DR
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1614
Practice Address - Country:US
Practice Address - Phone:207-444-5973
Practice Address - Fax:207-444-5520
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN24451163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MERN24451OtherSTATE NURSING LICENSE