Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R039058 | ME |
NPI | 1003099961 |
---|---|
Provider Name | Peggy A Ouellette |
First Address | Portland, ME 04102-1313 |
Second Address | Brunswick, ME 04011-2609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2007 |
Last Update Date | 13/12/2007 |