Provider Demographics
NPI:1982917019
Name:CHARETTE, PAULA S (FNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:S
Last Name:CHARETTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 ALLAGASH RD
Mailing Address - Street 2:STE 1
Mailing Address - City:ALLAGASH
Mailing Address - State:ME
Mailing Address - Zip Code:04774-4010
Mailing Address - Country:US
Mailing Address - Phone:207-398-1022
Mailing Address - Fax:207-398-1034
Practice Address - Street 1:1063 ALLAGASH RD
Practice Address - Street 2:STE 1
Practice Address - City:ALLAGASH
Practice Address - State:ME
Practice Address - Zip Code:04774-4010
Practice Address - Country:US
Practice Address - Phone:207-398-1022
Practice Address - Fax:207-398-1034
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP101038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1447693965Medicaid
ME1982917019Medicare NSC