MEDICARE: KRISTI PETRILLO STRAUB NP

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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	RN621580	PA
2	363L00000X	Nurse Practitioner	SP029090	PA

General Provider Information

NPI Number	:	1922871227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI PETRILLO STRAUB NP

Provider Business Mailing Address
First Line	:	2913 KENSINGTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-3016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2913 KENSINGTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-3016
Country	:	US
Telephone Number	:	215-634-5272
Fax Number	:

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

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	01/17/2024

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