Provider Demographics
NPI:1942235999
Name:PELLETIER, MARJORIE (APRN)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 ROUTE 108
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1543
Mailing Address - Country:US
Mailing Address - Phone:603-692-4018
Mailing Address - Fax:603-692-1083
Practice Address - Street 1:255 ROUTE 108
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1543
Practice Address - Country:US
Practice Address - Phone:603-692-4018
Practice Address - Fax:603-692-1083
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH026042-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30344883Medicaid
NHNP0237Medicare PIN