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General NPI Number Information
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NPI Number | 1922048073
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Entity Type | Individual
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Provider Name | MARY PETRUZZI APRN
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 9900 BREN RD E
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City | MINNETONKA
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State | MN
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Zip | 55343-9664
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Country | US
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Telephone | 203-605-0804
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Fax |
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Provider Business Mailing Address
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Address Line | 126 SHERMAN HILL RD APT C10
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City | WOODBURY
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State | CT
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Zip | 06798-3641
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Country | US
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Telephone | 203-605-0804
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F333230-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 002938
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2269965
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License Number State | MA
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