Physician Compare National (NPI:1760621304)

HEALTHCARE PROVIDER: MS. KERRI ANN PETITPAIN

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1760621304
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1153630611
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151023000050
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PETITPAIN
	Individual professional last name
Provider First Name	KERRI
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	18 SCOTT LN
	Group Practice or individual's line 1 address
City	MANORVILLE
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	119492624
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6319056890
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330185
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y