Provider Demographics
NPI:1982764676
Name:PELLETIER, DONNA M (ARNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LEAVITT FARM LANE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909
Mailing Address - Country:US
Mailing Address - Phone:207-363-8998
Mailing Address - Fax:
Practice Address - Street 1:396 HIGH STREET
Practice Address - Street 2:SEACOAST REDICARE
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878
Practice Address - Country:US
Practice Address - Phone:603-692-6006
Practice Address - Fax:603-692-4815
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH020835 23 03363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P17411Medicare UPIN
NP2824Medicare ID - Type Unspecified