MEDICARE: MR. JEFFREY PATRICK PETRILLO CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN317474L/52264	PA

General Provider Information

NPI Number	:	1942280110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY PATRICK PETRILLO CRNA

Provider Business Mailing Address
First Line	:	133 FLINT DR
Second Line	:
City	:	HARLEYSVILLE
State	:	PA
Zip	:	19438-1862
Country	:	US
Telephone Number	:	215-513-9333
Fax Number	:	215-513-0118

Provider Business Practice Location Address
First Line	:	1330 POWELL ST
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19401-3353
Country	:	US
Telephone Number	:	610-270-2717
Fax Number	:

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

Provider Enumeration Date	:	01/22/2006
Last Update Date	:	07/08/2007

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