Provider Demographics
NPI:1447944392
Name:PELLETIER, BETHANY A (APRN)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:A
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 COMPROMISE LN
Mailing Address - Street 2:
Mailing Address - City:SANDOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03873-2064
Mailing Address - Country:US
Mailing Address - Phone:603-401-9107
Mailing Address - Fax:
Practice Address - Street 1:380R MERRIMACK ST STE 3B
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5884
Practice Address - Country:US
Practice Address - Phone:978-687-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH070364-23363LF0000X
MARN2321607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily