Healthcare Provider Details

I. General information

NPI: 1710908249
Provider Name (Legal Business Name): AMY MARIE PETRUNAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GYPSY LN
YOUNGSTOWN OH
44504-1315
US

IV. Provider business mailing address

112 ROCKY LEDGE DR
STRUTHERS OH
44471-1466
US

V. Phone/Fax

Practice location:
  • Phone: 330-747-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number35068169P
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: