Provider Demographics
NPI:1154518603
Name:OUELLETTE, ELAINE B (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:B
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:ME
Mailing Address - Zip Code:04785-1028
Mailing Address - Country:US
Mailing Address - Phone:207-868-5221
Mailing Address - Fax:207-868-5222
Practice Address - Street 1:69 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:ME
Practice Address - Zip Code:04785-1028
Practice Address - Country:US
Practice Address - Phone:207-868-5221
Practice Address - Fax:207-868-5222
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES31604Medicare UPIN