Provider Demographics
NPI:1699291583
Name:PETRALIE, STEPHANIE (FNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PETRALIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 SHAWNEE MISSION PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2003
Mailing Address - Country:US
Mailing Address - Phone:913-588-8700
Mailing Address - Fax:
Practice Address - Street 1:2650 SHAWNEE MISSION PKWY
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-2003
Practice Address - Country:US
Practice Address - Phone:913-588-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5377828052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily