Provider Demographics
NPI:1649544610
Name:PELLETIER, NICHOLAS PAUL (PA-C)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:PAUL
Last Name:PELLETIER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1180 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1126
Mailing Address - Country:US
Mailing Address - Phone:401-253-8900
Mailing Address - Fax:401-254-1093
Practice Address - Street 1:1180 HOPE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-1126
Practice Address - Country:US
Practice Address - Phone:401-253-8900
Practice Address - Fax:401-254-1093
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2022-05-23
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant