Provider Demographics
NPI:1720574338
Name:WILLETTE, PAMELA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:WILLETTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:FORT FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04742-1021
Mailing Address - Country:US
Mailing Address - Phone:207-764-8529
Mailing Address - Fax:207-472-3609
Practice Address - Street 1:23 HIGH ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742-1021
Practice Address - Country:US
Practice Address - Phone:207-764-8529
Practice Address - Fax:207-472-3609
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN68537163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator