Provider Demographics
NPI:1447772694
Name:PETTENGILL, KATHERINE COLLINS (GNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:COLLINS
Last Name:PETTENGILL
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NORTHEASTERN BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3139
Mailing Address - Country:US
Mailing Address - Phone:978-441-0412
Mailing Address - Fax:
Practice Address - Street 1:11 NORTHEASTERN BLVD STE 340
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3139
Practice Address - Country:US
Practice Address - Phone:603-860-3893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH075197-23163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology