Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2328908 | MA |
NPI | 1023619699 |
---|---|
Provider Name | Alison Pelletier |
First Address | Beverly, MA 01915-5510 |
Second Address | Beverly, MA 01915-5510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2020 |
Last Update Date | 12/03/2021 |