MEDICARE: PAULA PETROWSKI CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN333833L	PA
2	367500000X	Certified Registered Nurse Anesthetist	331287	NY

General Provider Information

NPI Number	:	1023012986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA PETROWSKI CRNA

Provider Business Mailing Address
First Line	:	PO BOX 551420
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33355-1420
Country	:	US
Telephone Number	:	866-507-5244
Fax Number	:	855-851-4405

Provider Business Practice Location Address
First Line	:	6511 SPRINGBROOK AVE
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572
Country	:	US
Telephone Number	:	610-250-4303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	05/09/2014

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