Provider Demographics
NPI:1881649283
Name:NOVELETSKY, HOLLIE T (ARNP)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:T
Last Name:NOVELETSKY
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 1:66 SOUTHSIDE RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-5117
Mailing Address - Country:US
Mailing Address - Phone:207-363-9231
Mailing Address - Fax:
Practice Address - Street 1:75 LINDALL ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2121
Practice Address - Country:US
Practice Address - Phone:978-774-4400
Practice Address - Fax:617-244-1827
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH035703-23-06363L00000X
MER051152363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30005926Medicaid
ME079051OtherBC/BS
ME431895999Medicaid
MENP5071Medicare ID - Type UnspecifiedMEDICARE
NH30005926Medicaid
R88182Medicare UPIN