Provider Demographics
NPI:1295202471
Name:PETIT-FRERE, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PETIT-FRERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1129
Mailing Address - Country:US
Mailing Address - Phone:781-266-8960
Mailing Address - Fax:
Practice Address - Street 1:16 GREENDALE RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02126-1530
Practice Address - Country:US
Practice Address - Phone:781-266-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN85474164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse