Provider Demographics
NPI:1023614286
Name:PETRANGELO, LINDSEY DIANE (FNP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:DIANE
Last Name:PETRANGELO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-1082
Mailing Address - Country:US
Mailing Address - Phone:413-896-0891
Mailing Address - Fax:
Practice Address - Street 1:160 HAZARD AVE STE 103
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4520
Practice Address - Country:US
Practice Address - Phone:860-962-6600
Practice Address - Fax:860-962-6866
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2273018363LF0000X
CT10643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2273018Medicaid