Provider Demographics
NPI:1497233985
Name:PETRO, PAMELA (NP-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PETRO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15258 MUNN RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:OH
Mailing Address - Zip Code:44065-9551
Mailing Address - Country:US
Mailing Address - Phone:440-668-8860
Mailing Address - Fax:
Practice Address - Street 1:36001 EUCLID AVE STE C19
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4651
Practice Address - Country:US
Practice Address - Phone:440-946-0053
Practice Address - Fax:440-946-1812
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily