MEDICARE: MS. EILEEN PATRICIA PETRALIA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	06381	TN

General Provider Information

NPI Number	:	1639112006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EILEEN PATRICIA PETRALIA FNP

Provider Business Mailing Address
First Line	:	2101 E YESLER WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-5959
Country	:	US
Telephone Number	:	206-299-1969
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 E YESLER WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-5959
Country	:	US
Telephone Number	:	206-299-1969
Fax Number	:	206-299-1902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	10/24/2011

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