Provider Demographics
NPI:1376873331
Name:CRETILLI AND ASSOCIATES, PA
Entity Type:Organization
Organization Name:CRETILLI AND ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CRETILLI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNS, PHD
Authorized Official - Phone:612-822-2714
Mailing Address - Street 1:5430 EDGEWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2604
Mailing Address - Country:US
Mailing Address - Phone:612-822-2714
Mailing Address - Fax:
Practice Address - Street 1:5430 EDGEWATER BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2604
Practice Address - Country:US
Practice Address - Phone:612-822-2714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN77D30CROtherBLUE CROSS BLUE SHIELD OF MINNESOTA