Provider Demographics
NPI:1326180431
Name:GUILBEAULT, PAM L (PA-C)
Entity type:Individual
Prefix:MS
First Name:PAM
Middle Name:L
Last Name:GUILBEAULT
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:PAM
Other - Middle Name:L
Other - Last Name:VORHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2 LIVEWELL DR
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6762
Mailing Address - Country:US
Mailing Address - Phone:207-467-6900
Mailing Address - Fax:207-467-6921
Practice Address - Street 1:2 LIVEWELL DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6762
Practice Address - Country:US
Practice Address - Phone:207-467-6900
Practice Address - Fax:207-467-6921
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1079363AM0700X, 363AM0700X
MEPA345363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMV1379812OtherMAINE DEA