Provider Demographics
NPI:1821101130
Name:PENDOLEY, DONNA M (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:PENDOLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-1612
Mailing Address - Country:US
Mailing Address - Phone:978-688-9979
Mailing Address - Fax:978-688-7727
Practice Address - Street 1:451 ANDOVER ST
Practice Address - Street 2:SUITE 335
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5044
Practice Address - Country:US
Practice Address - Phone:978-688-9979
Practice Address - Fax:978-688-7727
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159886363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0388131Medicaid
MA159886OtherLICENSE
MAP46042Medicare UPIN
MANP3622Medicare ID - Type UnspecifiedMEDICARE NUMBER