Healthcare Provider Details

I. General information

NPI: 1285908293
Provider Name (Legal Business Name): LORI S PETRUCCIANI N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6336 AVALON LANE EAST DR
INDIANAPOLIS IN
46220-5080
US

IV. Provider business mailing address

6336 AVALON LANE EAST DR
INDIANAPOLIS IN
46220-5080
US

V. Phone/Fax

Practice location:
  • Phone: 317-915-1525
  • Fax:
Mailing address:
  • Phone: 317-915-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: