Provider Demographics
NPI:1356827778
Name:PELLETIER, SANDRA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:FNP-C
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 1959
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-1959
Mailing Address - Country:US
Mailing Address - Phone:207-657-7733
Mailing Address - Fax:207-657-7744
Practice Address - Street 1:39 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2855
Practice Address - Country:US
Practice Address - Phone:207-657-7733
Practice Address - Fax:207-657-7744
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner