Doctor Name: | DEVIN LEE PETULLA |
NPI Number: | 1033599519 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | SP015013 |
Business Practice Address: | 222 Chestnut Ave Altoona, PA - 166014928 |
Business Phone Number: | 8149468046 |
Business Fax Number: | 8149463693 |
Mailing Address: | 222 Chestnut Ave, ALTOONA |
State: | PA |
Postal Code: | 166014928 |
Phone Number: | 8149468046 |
Fax Number: | 8149463693 |
NPI Enumeration Date: | 06/01/2015 |
NPI Last Update Date: | 04/13/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | SP015013 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |