Provider Demographics
NPI:1154495497
Name:DUQUETTE, PETER (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:DUQUETTE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 PROSPECT STREET
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-2799
Mailing Address - Country:US
Mailing Address - Phone:508-825-1800
Mailing Address - Fax:508-825-8101
Practice Address - Street 1:57 PROSPECT STREET
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2799
Practice Address - Country:US
Practice Address - Phone:508-825-1800
Practice Address - Fax:508-825-8101
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRNA18913367500000X
MA185171367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA110301OtherMCR PIN MA
MANA110302OtherMCR PIN MA
NA1103OtherBCBS
MAJX2704Medicare PIN
MANA110302OtherMCR PIN MA
MAJX2451Medicare PIN
RINA1103Medicare ID - Type Unspecified