Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN2268293 | MA |
NPI | 1649718198 |
---|---|
Provider Name | Julie Ann Pelletier |
First Address | Fitchburg, MA 01420-1914 |
Second Address | Fitchburg, MA 01420-1914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2017 |
Last Update Date | 15/09/2017 |