1477920080 NPI number — LYNNE MARIE PELLETIER RN-BSN

Table of content: LYNNE MARIE PELLETIER RN-BSN (NPI 1477920080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477920080 NPI number — LYNNE MARIE PELLETIER RN-BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELLETIER
Provider First Name:
LYNNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN-BSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477920080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE LAKE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04739-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-444-5973
Provider Business Mailing Address Fax Number:
207-444-5520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 MOUNTAINVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT KENT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04743-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-444-5973
Provider Business Practice Location Address Fax Number:
207-444-5520
Provider Enumeration Date:
08/31/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN24451 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN24451 . This is a "STATE NURSING LICENSE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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