Provider Demographics
NPI:1407833155
Name:PELLETIER, CAROL (ARNP,DNP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:ARNP,DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W HOLLIS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1358
Mailing Address - Country:US
Mailing Address - Phone:603-577-1613
Mailing Address - Fax:603-809-4934
Practice Address - Street 1:505 W HOLLIS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1358
Practice Address - Country:US
Practice Address - Phone:603-577-1613
Practice Address - Fax:603-809-4934
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH032840-23-03363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH500018329Medicaid
NH500018329Medicaid
NHS99747Medicare UPIN