Basic Information
| Provider Information | |||||||||
| NPI: | 1982917019 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHARETTE | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1063 ALLAGASH RD | ||||||||
| Address2: | STE 1 | ||||||||
| City: | ALLAGASH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047744010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073981022 | ||||||||
| FaxNumber: | 2073981034 | ||||||||
| Practice Location | |||||||||
| Address1: | 1063 ALLAGASH RD | ||||||||
| Address2: | STE 1 | ||||||||
| City: | ALLAGASH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047744010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073981022 | ||||||||
| FaxNumber: | 2073981034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2010 | ||||||||
| LastUpdateDate: | 12/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP101038 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1447693965 | 05 | ME | MEDICAID |