Healthcare Provider Details

I. General information

NPI: 1316517980
Provider Name (Legal Business Name): AMANDA KATHLEEN PETRELLA DNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 FORREST AVE
DOVER DE
19904-2799
US

IV. Provider business mailing address

PO BOX 151
NEW CASTLE DE
19720-0151
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-4622
  • Fax:
Mailing address:
  • Phone: 302-652-2455
  • Fax: 302-322-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0045354
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0011695
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: