Provider Demographics
NPI:1437132354
Name:PETRULIAS, LINDA ROOKLIN (RN/FNP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ROOKLIN
Last Name:PETRULIAS
Suffix:
Gender:F
Credentials:RN/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SILVIA DR
Mailing Address - Street 2:
Mailing Address - City:CAZADERO
Mailing Address - State:CA
Mailing Address - Zip Code:95421-9690
Mailing Address - Country:US
Mailing Address - Phone:707-632-5532
Mailing Address - Fax:707-632-5532
Practice Address - Street 1:3317 CHANATE RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-1737
Practice Address - Country:US
Practice Address - Phone:707-570-3873
Practice Address - Fax:707-570-3874
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 281484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF 1766OtherFURNISHING NUMBER
CARN 281484OtherLICENSE