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General NPI Number Information
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NPI Number | 1336728278
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Entity Type | Individual
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Provider Name | NICOLE PETRILLO MD
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Gender | Female
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 7440 W FRONTAGE RD
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City | SHAWNEE MISSION
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State | KS
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Zip | 66203-4670
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Country | US
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Telephone | 913-236-6455
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Fax |
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Provider Business Mailing Address
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Address Line | 10906 W 169TH TER
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City | OVERLAND PARK
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State | KS
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Zip | 66221-7954
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Country | US
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Telephone | 913-206-2196
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 04-50947
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License Number State | KS
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