Healthcare Provider Details

I. General information

NPI: 1164185179
Provider Name (Legal Business Name): CAROL ANNE PETRINI MSN, RNC-NIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2021
Last Update Date: 10/17/2021
Certification Date: 10/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

IV. Provider business mailing address

730 N MAIN ST
INDEPENDENCE MO
64050-2828
US

V. Phone/Fax

Practice location:
  • Phone: 816-694-4286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number135728
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number135728
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: