Provider Demographics
NPI:1154307882
Name:PELLEGRIN, BARBARA JEAN (CNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:PELLEGRIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:WADE
Other - Last Name:PELLEGRIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:604 ANN ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5122
Mailing Address - Country:US
Mailing Address - Phone:304-424-2400
Mailing Address - Fax:304-865-5036
Practice Address - Street 1:604 ANN ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5122
Practice Address - Country:US
Practice Address - Phone:304-424-2400
Practice Address - Fax:304-865-5036
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN213748163WD0400X
OHNP01667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENP18372Medicare PIN
S95831Medicare UPIN