| Doctor Name: | BLYTHE PETRELLA |
| NPI Number: | 1477804573 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 13732 |
| Business Practice Address: | 9772 Diagonal Rd Mantua, OH - 442559128 |
| Business Phone Number: | 3302742272 |
| Business Fax Number: | 3307322492 |
| Mailing Address: | 9772 Diagonal Rd, MANTUA |
| State: | OH |
| Postal Code: | 442559128 |
| Phone Number: | 3302742272 |
| Fax Number: | 3307322492 |
| NPI Enumeration Date: | 09/28/2012 |
| NPI Last Update Date: | 09/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 13732 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |