Provider Demographics
NPI:1578944922
Name:CAROL A PELLETIER APRN,DNP
Entity Type:Organization
Organization Name:CAROL A PELLETIER APRN,DNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PELLETIER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,DNP
Authorized Official - Phone:603-577-1613
Mailing Address - Street 1:505 W HOLLIS ST
Mailing Address - Street 2:#106
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1358
Mailing Address - Country:US
Mailing Address - Phone:603-577-1613
Mailing Address - Fax:603-809-4934
Practice Address - Street 1:505 W HOLLIS ST
Practice Address - Street 2:#106
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1358
Practice Address - Country:US
Practice Address - Phone:603-577-1613
Practice Address - Fax:603-809-4934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH032840-2303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHS99747Medicare UPIN