Provider Demographics
NPI:1124432497
Name:PETRUSIC, ERIN (APN, PMHNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:PETRUSIC
Suffix:
Gender:F
Credentials:APN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 W 32ND PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6269
Mailing Address - Country:US
Mailing Address - Phone:312-217-4366
Mailing Address - Fax:
Practice Address - Street 1:1140 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-4096
Practice Address - Country:US
Practice Address - Phone:773-536-2700
Practice Address - Fax:773-536-2703
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001784363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health