Provider Demographics
NPI:1326470154
Name:PETRIE, LINDSEY RAE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:RAE
Last Name:PETRIE
Suffix:
Gender:F
Credentials:FNP
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Other - Credentials:
Mailing Address - Street 1:755 JEFFERSON RD
Mailing Address - Street 2:STE 110
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3233
Mailing Address - Country:US
Mailing Address - Phone:585-419-7948
Mailing Address - Fax:585-385-6071
Practice Address - Street 1:6713 COLLAMER RD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9759
Practice Address - Country:US
Practice Address - Phone:315-463-0421
Practice Address - Fax:585-385-6071
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY337988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400364674Medicare PIN