Provider Demographics
NPI:1275945180
Name:PETRUOLO, ROCCO (R N)
Entity Type:Individual
Prefix:MR
First Name:ROCCO
Middle Name:
Last Name:PETRUOLO
Suffix:
Gender:M
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6956 WICKERSHAM DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5156
Mailing Address - Country:US
Mailing Address - Phone:910-257-5280
Mailing Address - Fax:
Practice Address - Street 1:6956 WICKERSHAM DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-5156
Practice Address - Country:US
Practice Address - Phone:910-257-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN238433163WM0705X
NC149246163WM0705X
CA579317163WM0705X
NVTRN308154163WM0705X
FLRN9204156163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical