Healthcare Provider Details

I. General information

NPI: 1578944922
Provider Name (Legal Business Name): CAROL A PELLETIER APRN,DNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W HOLLIS ST #106
NASHUA NH
03062-1358
US

IV. Provider business mailing address

505 W HOLLIS ST #106
NASHUA NH
03062-1358
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-1613
  • Fax: 603-809-4934
Mailing address:
  • Phone: 603-577-1613
  • Fax: 603-809-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number032840-2303
License Number StateNH

VIII. Authorized Official

Name: MRS. CAROL A PELLETIER
Title or Position: PROVIDER/OWNER
Credential: APRN,DNP
Phone: 603-577-1613