=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427795533
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAREEN PETTINGER PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2022
-----------------------------------------------------
Last Update Date | 10/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 WRIGHT STREET 1ST FLOOR
-----------------------------------------------------
City | PALMER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01069-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-370-5400
-----------------------------------------------------
Fax | 413-370-5654
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 280 CHESTNUT STREET 2ND FLOOR
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01199-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-794-3909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------