Provider Demographics
NPI:1790984110
Name:PELLETIER, MYRIAM (MS)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 E IRONWOOD SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4569
Mailing Address - Country:US
Mailing Address - Phone:480-551-9700
Mailing Address - Fax:480-551-9750
Practice Address - Street 1:9440 E IRONWOOD SQUARE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4569
Practice Address - Country:US
Practice Address - Phone:480-551-9700
Practice Address - Fax:480-551-9750
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS