Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CNP171066 | ME |
NPI | 1003356809 |
---|---|
Provider Name | Allison Guerrette |
First Address | Caribou, ME 04736-0040 |
Second Address | Van Buren, ME 04785-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2017 |
Last Update Date | 21/06/2017 |