Doctor Name: | LORRIE ANN PETTENGILL |
NPI Number: | 1740639210 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 24 Hoyt St Springvale, ME - 040831710 |
Business Phone Number: | 2077300968 |
Business Fax Number: | 2078501184 |
Mailing Address: | 24 Hoyt St, SPRINGVALE |
State: | ME |
Postal Code: | 040831710 |
Phone Number: | 2077300968 |
Fax Number: | 2078501184 |
NPI Enumeration Date: | 06/06/2016 |
NPI Last Update Date: | 06/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA0600X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Adult Day Care |
Taxonomy Definition: |