Provider Demographics
NPI:1952636318
Name:GAUDETTE, ELIZABETH (RN, LCCE, CD(DONA))
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GAUDETTE
Suffix:
Gender:F
Credentials:RN, LCCE, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-6838
Mailing Address - Country:US
Mailing Address - Phone:207-363-1379
Mailing Address - Fax:
Practice Address - Street 1:11 3RD AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-6838
Practice Address - Country:US
Practice Address - Phone:207-363-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER049622374J00000X
MA114354374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula