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General NPI Number Information
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NPI Number | 1528499860
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Entity Type | Individual
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Provider Name | CHRISTA MARIE PETKO CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | ONE MEDICAL CENTER DRIVE
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City | MORGANTOWN
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State | WV
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Zip | 26506-8133
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Country | US
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Telephone | 304-598-4156
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER DRIVE
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City | MORGANTOWN
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State | WV
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Zip | 26506-8133
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Country | US
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Telephone |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 101309
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License Number State | PA
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Taxonomy #2
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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 | RN602564
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License Number State | PA
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Taxonomy #3
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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 | 73657
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License Number State | WV
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