Provider Demographics
NPI:1427077312
Name:CORMIER, RONALD E (FNP)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:CORMIER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:ME
Mailing Address - Zip Code:04921-0159
Mailing Address - Country:US
Mailing Address - Phone:207-722-3488
Mailing Address - Fax:207-722-3183
Practice Address - Street 1:55 REYNOLDS ROAD
Practice Address - Street 2:
Practice Address - City:BROOKS
Practice Address - State:ME
Practice Address - Zip Code:04921-0159
Practice Address - Country:US
Practice Address - Phone:207-722-3488
Practice Address - Fax:207-722-3183
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER023149363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q00089Medicare UPIN