Provider Demographics
NPI:1033599519
Name:PETULLA, DEVIN LEE (CRNP)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:LEE
Last Name:PETULLA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:
Other - Last Name:BURNSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4928
Mailing Address - Country:US
Mailing Address - Phone:814-946-8046
Mailing Address - Fax:814-946-3693
Practice Address - Street 1:222 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4928
Practice Address - Country:US
Practice Address - Phone:814-946-8046
Practice Address - Fax:814-946-3693
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily