Provider Demographics
NPI:1770828857
Name:PEAVEY-MITCHELL, CARLARAE JEAN (PMH-NP)
Entity Type:Individual
Prefix:MR
First Name:CARLARAE
Middle Name:JEAN
Last Name:PEAVEY-MITCHELL
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 STILLWATER AVE # 422
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3945
Mailing Address - Country:US
Mailing Address - Phone:207-973-5646
Mailing Address - Fax:207-973-6040
Practice Address - Street 1:268 STILLWATER AVE # 422
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:207-973-5646
Practice Address - Fax:207-973-6040
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP 121115363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health