Basic Information
| Provider Information | |||||||||
| NPI: | 1881649283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVELETSKY | ||||||||
| FirstName: | HOLLIE | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 SOUTHSIDE RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039095117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073639231 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 LINDALL ST | ||||||||
| Address2: | |||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019232121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787744400 | ||||||||
| FaxNumber: | 6172441827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 12/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 035703-23-06 | NH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | R051152 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 30005926 | 05 | NH | MEDICAID | 079051 | 01 | ME | BC/BS | OTHER | 431895999 | 05 | ME | MEDICAID |