Provider Demographics
NPI:1649683129
Name:JETTE-GONTHIER, TRICIA RENEE (APRN)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:RENEE
Last Name:JETTE-GONTHIER
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:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-577-7900
Mailing Address - Fax:603-577-7972
Practice Address - Street 1:17 PROSPECT ST
Practice Address - Street 2:SUITE N 203
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3956
Practice Address - Country:US
Practice Address - Phone:603-577-2663
Practice Address - Fax:603-577-3366
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH073308-23363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health