Provider Demographics
NPI:1285908293
Name:PETRUCCIANI, LORI S (ND)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:S
Last Name:PETRUCCIANI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 AVALON LANE EAST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-5080
Mailing Address - Country:US
Mailing Address - Phone:317-915-1525
Mailing Address - Fax:
Practice Address - Street 1:6336 AVALON LANE EAST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-5080
Practice Address - Country:US
Practice Address - Phone:317-915-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No174H00000XOther Service ProvidersHealth Educator