Basic Information
| Provider Information | |||||||||
| NPI: | 1447693965 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARETTE PRIMARY HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 CARSON LN | ||||||||
| Address2: | |||||||||
| City: | FORT KENT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047431474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073981022 | ||||||||
| FaxNumber: | 2077646504 | ||||||||
| Practice Location | |||||||||
| Address1: | 1063 ALLAGASH RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | ALLAGASH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047744010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073981022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2013 | ||||||||
| LastUpdateDate: | 04/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | CHARETTE | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2073164655 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN-CNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.