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General NPI Number Information
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NPI Number | 1760621304
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Entity Type | Individual
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Provider Name | MS. KERRI ANN PETITPAIN
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Gender | Female
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 18 SCOTT LN
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City | MANORVILLE
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State | NY
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Zip | 11949-2624
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Country | US
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Telephone | 631-905-6890
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Fax | 888-920-2296
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Provider Business Mailing Address
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Address Line | 18 SCOTT LN
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City | MANORVILLE
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State | NY
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Zip | 11949-2624
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Country | US
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Telephone | 631-764-5561
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Fax | 503-386-2841
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 333951
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License Number State | NY
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