Provider Demographics
NPI:1386696433
Name:POMERLEAU, RITA L (FNPC/ARNP-C)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:L
Last Name:POMERLEAU
Suffix:
Gender:F
Credentials:FNPC/ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-1203
Mailing Address - Country:US
Mailing Address - Phone:207-384-9212
Mailing Address - Fax:207-384-2008
Practice Address - Street 1:57 PORTLAND ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-1203
Practice Address - Country:US
Practice Address - Phone:207-384-9212
Practice Address - Fax:207-384-2008
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER038146363LF0000X
MEAP081482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME277870099Medicaid
ME277870099Medicaid