Provider Demographics
NPI:1366653206
Name:PETRILLO, CINDY LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:LYNN
Last Name:PETRILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 SANBUSCO DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5302
Mailing Address - Country:US
Mailing Address - Phone:505-867-7449
Mailing Address - Fax:
Practice Address - Street 1:5036 SANBUSCO DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-5302
Practice Address - Country:US
Practice Address - Phone:505-867-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR44319163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse