Provider Demographics
NPI:1740639210
Name:PETTENGILL, LORRIE ANN
Entity type:Individual
Prefix:
First Name:LORRIE
Middle Name:ANN
Last Name:PETTENGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HOYT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1710
Mailing Address - Country:US
Mailing Address - Phone:207-730-0968
Mailing Address - Fax:207-850-1184
Practice Address - Street 1:24 HOYT ST
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1710
Practice Address - Country:US
Practice Address - Phone:207-730-0968
Practice Address - Fax:207-850-1184
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care