Provider Demographics
NPI:1073235313
Name:CETRANGOLO, HOLLEY ALICIA
Entity Type:Individual
Prefix:
First Name:HOLLEY
Middle Name:ALICIA
Last Name:CETRANGOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLEY
Other - Middle Name:
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 VT RTE 12 N
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05663-4436
Mailing Address - Country:US
Mailing Address - Phone:802-279-9155
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0029792163WN0002X
NH056107-23363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care