Provider Demographics
NPI:1447480264
Name:BLANCHETTE, LAUREN A (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:BLANCHETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:FOURNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:149 MAIN ST
Mailing Address - Street 2:STE 2A
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-1486
Mailing Address - Country:US
Mailing Address - Phone:207-624-3800
Mailing Address - Fax:207-624-3845
Practice Address - Street 1:149 MAIN ST
Practice Address - Street 2:STE 2A
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-1486
Practice Address - Country:US
Practice Address - Phone:207-624-3800
Practice Address - Fax:207-624-3845
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001175363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1447480264Medicaid
ME1447480264Medicaid