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General NPI Number Information
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NPI Number | 1124432497
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Entity Type | Individual
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Provider Name | ERIN PETRUSIC APN, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 12/23/2023
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Provider Practice Location Address
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Address Line | 1140 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60642-4096
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Country | US
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Telephone | 773-536-2700
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Fax | 773-536-2703
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Provider Business Mailing Address
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Address Line | 2403 W 32ND PL
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City | CHICAGO
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State | IL
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Zip | 60608-6269
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Country | US
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Telephone | 312-217-4366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277001784
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License Number State | IL
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