Provider Demographics
NPI:1477129047
Name:LORRAINE, ABIGAIL GRACE PELLETIER (MD, MPH)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:GRACE PELLETIER
Last Name:LORRAINE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:GRACE
Other - Last Name:PELLETIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3960 COON RAPIDS BLVD NW STE 200
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2569
Mailing Address - Country:US
Mailing Address - Phone:763-236-9236
Mailing Address - Fax:763-236-9250
Practice Address - Street 1:3960 COON RAPIDS BLVD NW STE 200
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2569
Practice Address - Country:US
Practice Address - Phone:763-236-9236
Practice Address - Fax:763-236-9250
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME159250207V00000X, 207V00000X
MN80175207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology