Provider Demographics
NPI:1144654807
Name:PETRUCELLI, ANNETTE ELISA (RN)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:ELISA
Last Name:PETRUCELLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:PETRUCELLI
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1691 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ROYALTON
Mailing Address - State:VT
Mailing Address - Zip Code:05068-5056
Mailing Address - Country:US
Mailing Address - Phone:802-238-8547
Mailing Address - Fax:
Practice Address - Street 1:1691 DAVIS RD
Practice Address - Street 2:
Practice Address - City:SOUTH ROYALTON
Practice Address - State:VT
Practice Address - Zip Code:05068-5056
Practice Address - Country:US
Practice Address - Phone:802-238-8547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0260013641163W00000X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support