Provider Demographics
NPI:1326487075
Name:PETITME, MARIE EDITH (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:EDITH
Last Name:PETITME
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 1:506 LENOX AVE
Mailing Address - Street 2:MLK 6227
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037
Mailing Address - Country:US
Mailing Address - Phone:212-939-1277
Mailing Address - Fax:212-939-2195
Practice Address - Street 1:75 BROAD ST RM 815
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-3233
Practice Address - Country:US
Practice Address - Phone:718-391-0611
Practice Address - Fax:718-732-2638
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-16
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337573363LF0000X
NYF337573-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily