Provider Demographics
NPI:1619934932
Name:GUILLETTE, CAROLYN M (PAC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:GUILLETTE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:PAPPAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-658-1277
Mailing Address - Fax:603-658-1278
Practice Address - Street 1:3 ALUMNI DR STE 204
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2122
Practice Address - Country:US
Practice Address - Phone:603-658-1277
Practice Address - Fax:603-658-1278
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0327363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076083Medicaid
NH3076083Medicaid
NHAP134604Medicare PIN
NH30332231Medicaid
NHAP1346Medicare ID - Type Unspecified