Provider Demographics
NPI:1396985057
Name:PETRILLO, ANN V (CRNP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:V
Last Name:PETRILLO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:215-361-5020
Mailing Address - Fax:215-362-1195
Practice Address - Street 1:125 MEDICAL CAMPUS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-7205
Practice Address - Country:US
Practice Address - Phone:215-361-5836
Practice Address - Fax:215-362-1195
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004706M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist